| Doctor Name: | MR. JORGE L GUTIERREZ |
| NPI Number: | 1053585240 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RAS |
| License Number: | |
| Business Practice Address: | 161 Miles Ln Watsonville, CA - 950763127 |
| Business Phone Number: | 8317615422 |
| Business Fax Number: | 8317613772 |
| Mailing Address: | 161 Miles Ln, WATSONVILLE |
| State: | CA |
| Postal Code: | 950763127 |
| Phone Number: | 8317615422 |
| Fax Number: | 8317613772 |
| NPI Enumeration Date: | 04/17/2008 |
| NPI Last Update Date: | 04/17/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |