Basic Information
| Provider Information | |||||||||
| NPI: | 1164731071 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | JOAN | ||||||||
| MiddleName: | GUTIERREZ | ||||||||
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| Credential: | FAMILY NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4540 E 7TH ST | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908044327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5623441150 | ||||||||
| FaxNumber: | 5623441155 | ||||||||
| Practice Location | |||||||||
| Address1: | 4540 E 7TH ST | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908044327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5623441150 | ||||||||
| FaxNumber: | 5623441155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2010 | ||||||||
| LastUpdateDate: | 09/27/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 19051 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.