Provider Demographics
NPI:1144907304
Name:DUTRA, GUADALUPE NONE
Entity type:Individual
Prefix:MRS
First Name:GUADALUPE
Middle Name:NONE
Last Name:DUTRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 CHAPEL HILL CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4009
Mailing Address - Country:US
Mailing Address - Phone:200-993-5161
Mailing Address - Fax:
Practice Address - Street 1:2311 CHAPEL HILL CIR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4009
Practice Address - Country:US
Practice Address - Phone:200-993-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician