Basic Information
| Provider Information | |||||||||
| NPI: | 1689277469 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUTIERREZ ANGEL | ||||||||
| FirstName: | RODOLFO | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | I | ||||||||
| Credential: | MSW, ASW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1448 E 48TH ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900114302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235712877 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4650 W SUNSET BLVD # 53 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900276062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233613849 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2020 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 97574 | CA | N | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | 97574 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | 97574 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.