Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 41542 | CA |
NPI | 1003213539 |
---|---|
Provider Name | Andrea C Gutierrez |
First Address | Thousand Oaks, CA 91361-1088 |
Second Address | Thousand Oaks, CA 91361-1088 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2014 |
Last Update Date | 26/11/2014 |