Individual
MISS MONICA GUTIERREZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CHW
Contact information
Practice address
2101 CULLISON LN, GRANTS PASS, OR 97527-5735
(541) 622-1433
Mailing address
2101 CULLISON LN, GRANTS PASS, OR 97527-5735
(541) 622-1433
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
108206
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5520691
OREGON DRIVERS LICENSE
OR
Enumeration date
01/30/2023
Last updated
01/30/2023
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