Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053635136 |
---|---|
Provider Name | Ms. Susan Gutierrez |
First Address | Santa Fe Springs, CA 90670-3362 |
Second Address | Santa Fe Springs, CA 90670-3362 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2010 |
Last Update Date | 18/03/2010 |