Provider Demographics
NPI:1053869677
Name:NICOLAS GUTIERREZ, BETZABEE
Entity type:Individual
Prefix:
First Name:BETZABEE
Middle Name:
Last Name:NICOLAS GUTIERREZ
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 1:698 EL CENTRO RD
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-1704
Mailing Address - Country:US
Mailing Address - Phone:510-230-6834
Mailing Address - Fax:
Practice Address - Street 1:195 AVIATION WAY STE 200
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2059
Practice Address - Country:US
Practice Address - Phone:831-728-8250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29194124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist