Basic Information
| Provider Information | |||||||||
| NPI: | 1033620950 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUTIERREZ | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | ALEXANDRA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PHYSICAL THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12411 SLAUSON AVE STE H | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906062835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626935449 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12411 SLAUSON AVE STE H | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906062835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626935449 | ||||||||
| FaxNumber: | 5626935449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2017 | ||||||||
| LastUpdateDate: | 10/18/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT20721 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.