Basic Information
Provider Information
NPI: 1053455261
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GUTIERREZ
FirstName: KATHLEEN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1804 EMBARCADERO RD
Address2: STE 100
City: PALO ALTO
State: CA
PostalCode: 943033341
CountryCode: US
TelephoneNumber: 6504978000
FaxNumber:  
Practice Location
Address1: 300 PASTEUR DR
Address2:  
City: STANFORD
State: CA
PostalCode: 943052200
CountryCode: US
TelephoneNumber: 6507235682
FaxNumber: 6507258040
Other Information
ProviderEnumerationDate: 02/19/2007
LastUpdateDate: 10/13/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080P0208XG69973CAY Allopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases

No ID Information.


Home