Provider Demographics
NPI:1548622830
Name:GUTIERREZ, PATRICIA MARIA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIA
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 1:12201 CREST AVE
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-5500
Mailing Address - Country:US
Mailing Address - Phone:818-272-9735
Mailing Address - Fax:
Practice Address - Street 1:8550 BALBOA BLVD STE 150
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325
Practice Address - Country:US
Practice Address - Phone:818-830-0200
Practice Address - Fax:818-830-0206
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT111163106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist