Provider Demographics
NPI:1871077420
Name:GUTIERREZ, PRISCILLA JENNIFER
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:JENNIFER
Last Name:GUTIERREZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582-2770
Mailing Address - Country:US
Mailing Address - Phone:951-385-0631
Mailing Address - Fax:
Practice Address - Street 1:2545 S SAN JACINTO AVE # 22
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5317
Practice Address - Country:US
Practice Address - Phone:951-385-0631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula