Basic Information
| Provider Information | |||||||||
| NPI: | 1710469374 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUTIERREZ-DIAZ | ||||||||
| FirstName: | HAIDEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1761 S HAMILTON BLVD | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917665002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233000705 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3727 W 6TH ST STE 402 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900205112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2133657400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2018 | ||||||||
| LastUpdateDate: | 09/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ASW90740 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.