Provider Demographics
NPI:1881557783
Name:GUTIERREZ, RIGOBERTO R
Entity type:Individual
Prefix:
First Name:RIGOBERTO
Middle Name:R
Last Name:GUTIERREZ
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 1:434 SW COLLEGE ST APT 601B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5268
Mailing Address - Country:US
Mailing Address - Phone:562-489-5332
Mailing Address - Fax:562-489-5332
Practice Address - Street 1:12204 CLARETTA ST # 601B
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-6052
Practice Address - Country:US
Practice Address - Phone:562-489-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-08
Last Update Date:2025-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88505225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist