Provider Demographics
NPI:1245102441
Name:GUTIERREZ, EVANGELINA
Entity type:Individual
Prefix:
First Name:EVANGELINA
Middle Name:
Last Name:GUTIERREZ
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 1:41550 ECLECTIC ST
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-1967
Mailing Address - Country:US
Mailing Address - Phone:877-205-6269
Mailing Address - Fax:877-214-4220
Practice Address - Street 1:41550 ECLECTIC ST
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-1967
Practice Address - Country:US
Practice Address - Phone:877-205-6269
Practice Address - Fax:877-214-4220
Is Sole Proprietor?:No
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker