Provider Demographics
NPI:1295561546
Name:GUTIERREZ MORA, BRENDA ANGELICA
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:ANGELICA
Last Name:GUTIERREZ MORA
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 N THORNE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-5943
Mailing Address - Country:US
Mailing Address - Phone:559-639-3068
Mailing Address - Fax:
Practice Address - Street 1:2136 N THORNE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-5943
Practice Address - Country:US
Practice Address - Phone:559-639-3068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula