Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY18553 | CA |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1164557559 |
---|---|
Provider Name | Silvia Guadalupe Gutierrez |
First Address | Los Angeles, CA 90034-4968 |
Second Address | Los Angeles, CA 90010-1577 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 05/07/2016 |