Provider Demographics
NPI:1053570408
Name:GUTIERREZ, MARCELLA C (FNP, NP-C)
Entity type:Individual
Prefix:MS
First Name:MARCELLA
Middle Name:C
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:FNP, NP-C
Other - Prefix:MRS
Other - First Name:MARCELLA
Other - Middle Name:C
Other - Last Name:GUTIERREZ-BECERRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 12209
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-2209
Mailing Address - Country:US
Mailing Address - Phone:909-862-1191
Mailing Address - Fax:909-862-2768
Practice Address - Street 1:7000 BOULDER AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-3348
Practice Address - Country:US
Practice Address - Phone:909-862-1191
Practice Address - Fax:909-862-2768
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17545363LF0000X
CA64424163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine