Provider Demographics
NPI:1447991914
Name:GUTIERREZ, MYRA ALEJANDRA (DO)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:ALEJANDRA
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 ALTA DR
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-2991
Mailing Address - Country:US
Mailing Address - Phone:760-684-1784
Mailing Address - Fax:
Practice Address - Street 1:1403 LOMITA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-2086
Practice Address - Country:US
Practice Address - Phone:310-602-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program