Provider Demographics
NPI:1053518753
Name:GUTIERREZ-VILLAGOMEZ, DELIA
Entity type:Individual
Prefix:
First Name:DELIA
Middle Name:
Last Name:GUTIERREZ-VILLAGOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 IMPERIAL WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-1344
Mailing Address - Country:US
Mailing Address - Phone:707-253-6043
Mailing Address - Fax:707-253-6117
Practice Address - Street 1:650 IMPERIAL WAY STE 101
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-1344
Practice Address - Country:US
Practice Address - Phone:707-253-6043
Practice Address - Fax:707-253-6117
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 390200000X
CAASW1243061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program