Provider Demographics
NPI:1053175869
Name:GUTIERREZ, MINERVA (LVN)
Entity type:Individual
Prefix:
First Name:MINERVA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:MINERVA
Other - Middle Name:
Other - Last Name:CEJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:936 W BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-4802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:936 W BOSTON AVE
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-4802
Practice Address - Country:US
Practice Address - Phone:760-677-1710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA689314164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse