Provider Demographics
NPI:1871291005
Name:GUTIERREZ RIVERA, VICTOR HUGO
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:HUGO
Last Name:GUTIERREZ RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 E 7TH ST APT E4
Mailing Address - Street 2:
Mailing Address - City:HOLTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92250-1625
Mailing Address - Country:US
Mailing Address - Phone:928-398-7917
Mailing Address - Fax:
Practice Address - Street 1:1225 E 7TH ST APT E4
Practice Address - Street 2:
Practice Address - City:HOLTVILLE
Practice Address - State:CA
Practice Address - Zip Code:92250-1625
Practice Address - Country:US
Practice Address - Phone:928-398-7917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician