Individual provider Active NPI

Erasto Gutierrez, M.D.

  • Family Medicine Physician
  • Pomona, CA
National Provider Identifier
1104022581
Registry record updated Sep 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A110685 Issued in CA
Practice address
1749 N Garey Ave
Pomona, CA 91767-2913
Phone
(909) 729-5079
Fax
(909) 729-5081
NPI assigned
Jun 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD2012-00777 NM
Family Medicine Physician 207Q00000X RS20070324 NM
Family Medicine Physician 207Q00000X A110685 CA Primary

Addresses

Primary practice location

1749 N Garey Ave
Pomona, CA 91767-2913

Mailing address

1749 N Garey Ave
Pomona, CA 91767-2913
Phone (909) 729-5079

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130813000439 CA Practitioner - Family PracticePractitioner - General Practice 8224288550 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2006
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
3Titan Medical IncGroup PAC ID 9638527021, 3 clinicians

Practice addresses (Care Compare)

11311 Garvey Ave
El Monte, CA 91732-3301
Phone (626) 689-4111

1749 N Garey Ave
Pomona, CA 91767-2913
Phone (909) 729-5079

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD2012-00777NMMDFamily Medicine Physician
RS20070324NMMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
3Titan Medical Inc CurrentSince Oct 13, 2023 Accepting new patients
Erasto Gutierrez MD Inc Family Medicine CurrentSince Oct 18, 2019 Accepting new patients
3Titan Medical Inc CurrentSince Oct 13, 2023 Accepting new patients
Erasto Gutierrez MD Inc Past Accepting new patients
Erasto Gutierrez MD Inc Past Accepting new patients

Locations

11311 Garvey Ave
El Monte, CA 91732
Phone (626) 689-4111

1749 N Garey Ave
Ste 101
Pomona, CA 91767

1749 N Garey Ave
Pomona, CA 91767
Phone (909) 622-9988

22032 El Paseo
Ste 130
Rsm, CA 92688
Phone (949) 546-9958

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694649600000",
    "number": "1104022581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1749 N GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917672913",
            "telephone_number": "909-729-5079",
            "fax_number": "909-729-5081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1749 N GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917672913",
            "telephone_number": "909-729-5079",
            "fax_number": "909-729-5081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUTIERREZ",
        "first_name": "ERASTO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-22",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "MD2012-00777",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "RS20070324",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A110685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.