Individual provider Active NPI

Mark Gutierrez, DC

  • Chiropractor
  • Tustin, CA
National Provider Identifier
1114357969
Registry record updated Feb 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC32691 Issued in CA
Practice address
13732 Newport Ave Ste 1
Tustin, CA 92780-4698
Phone
(714) 406-0242
NPI assigned
Nov 14, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X DC32691 CA Primary

Addresses

Primary practice location

13732 Newport Ave Ste 1
Tustin, CA 92780-4698

Mailing address

13732 Newport Ave Ste 1
Tustin, CA 92780-4698
Phone (714) 406-0242

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211210001636 CA Practitioner - Chiropractic 6901296623 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

28122 S Western Ave
San Pedro, CA 90732-1248
Phone (310) 935-2470

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DC32691CAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Gutierrez Chiropractic Management Incorporated Chiropractor CurrentSince Aug 24, 2024 Accepting new patients
Santana Chiropractic Management Inc Chiropractor CurrentSince Aug 24, 2024 Accepting new patients
Czapla Chiropractic Inc. Past Accepting new patients

Locations

28122 S Western Ave
San Pedro, CA 90732
Phone (310) 935-2470

Organizations & group practices 3

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": "1384387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613347200000",
    "number": "1114357969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13732 NEWPORT AVE STE 1",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927804698",
            "telephone_number": "714-406-0242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13732 NEWPORT AVE STE 1",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927804698",
            "telephone_number": "714-406-0242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUTIERREZ",
        "first_name": "MARK",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-14",
        "last_updated": "2021-02-15",
        "certification_date": "2021-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC32691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.