Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 13956 | CA |
NPI | 1013275247 |
---|---|
Provider Name | Ricardo Jorge Gutierrez |
First Address | Whittier, CA 90602-3158 |
Second Address | Whittier, CA 90602-3158 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2012 |
Last Update Date | 14/11/2013 |