Provider Demographics
NPI:1679700017
Name:SANTOS, BARBARA-JEAN GUTIERREZ (MD)
Entity type:Individual
Prefix:
First Name:BARBARA-JEAN
Middle Name:GUTIERREZ
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:
Mailing Address - City:ETIWANDA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-0261
Mailing Address - Country:US
Mailing Address - Phone:917-524-9909
Mailing Address - Fax:
Practice Address - Street 1:7615 ETIWANDA AVE
Practice Address - Street 2:UNIT 261
Practice Address - City:ETIWANDA
Practice Address - State:CA
Practice Address - Zip Code:91739-7023
Practice Address - Country:US
Practice Address - Phone:917-524-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA121007207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine