Provider Demographics
NPI:1366978686
Name:GUTIERREZ, SARINA MARIE (PTS)
Entity type:Individual
Prefix:
First Name:SARINA
Middle Name:MARIE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:PTS
Other - Prefix:
Other - First Name:SARINA
Other - Middle Name:MARIE
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:11501 S VILLA CT
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-4361
Mailing Address - Country:US
Mailing Address - Phone:708-677-5673
Mailing Address - Fax:
Practice Address - Street 1:11501 S VILLA CT
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-4361
Practice Address - Country:US
Practice Address - Phone:708-677-5673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.007669405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional