Active NPI
Vanessa Ivette Gutierrez, RN, PNP, CRNP
- Pediatric Nurse Practitioner
- Truckee, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 95009713
- Practice address
- 10775 Pioneer TRL Ste 215
Truckee, CA 96161-0234 - Phone
- (415) 424-4266
- Fax
- (415) 520-6633
- NPI assigned
- Oct 31, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | R265873 | MD | |
| Pediatric Nurse Practitioner | 363LP0200X | APRN11031756 | FL | |
| Pediatric Nurse Practitioner | 363LP0200X | 95009713 | CA | Primary |
Addresses
Primary practice location
10775 Pioneer TRL Ste 215
Truckee, CA 96161-0234
Mailing address
8300 Esters Blvd Ste 900
Irving, TX 75063-2233
Phone (415) 424-4266
Other practice location 1
9100 S Dadeland Blvd Ste 1500
Miami, FL 33156-7816
Phone (415) 424-4266
Other practice location 2
16701 Melford Blvd Ste 400
Bowie, MD 20715-4411
Phone (415) 424-4266
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100366410 | Medicaid | CA |
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: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APRN11031756 | FL | MD | Pediatric Nurse Practitioner |
| R265873 | MD | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of San Mateo | Current | Accepting new patients | |
| County of San Mateo | Current | Accepting new patients | |
| County of San Mateo | Current | Accepting new patients | |
| Telehealth Services USA | Past | Accepting new patients | |
| Tiburcio Vasquez Health Center, Inc. | Past | Accepting new patients |
Locations
222 W 39th Ave
San Mateo, CA 94403
Phone (415) 573-2222
Interoperability endpoints
- vgutierrez25659@smch.direct-ci.com
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba San Mateo Medical Center
- Multi-Specialty Clinic/Center
- San Mateo, CA
- NPI 1679642326
-
dba San Mateo Medical Center
- Multi-Specialty Clinic/Center
- San Mateo, CA
- NPI 1831268580
-
- Federally Qualified Health Center (FQHC)
- Hayward, CA
- NPI 1144597477
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715731200000",
"number": "1194292763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8300 ESTERS BLVD STE 900",
"city": "IRVING",
"state": "TX",
"postal_code": "750632233",
"telephone_number": "415-424-4266",
"fax_number": "415-520-6633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10775 PIONEER TRL STE 215",
"city": "TRUCKEE",
"state": "CA",
"postal_code": "961610234",
"telephone_number": "415-424-4266",
"fax_number": "415-520-6633"
}
],
"practiceLocations": [
{
"address_1": "9100 S Dadeland Blvd Ste 1500",
"address_purpose": "LOCATION",
"city": "Miami",
"state": "FL",
"postal_code": "331567816",
"country_code": "US",
"telephone_number": "415-424-4266",
"fax_number": "415-520-6633",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "16701 Melford Blvd Ste 400",
"address_purpose": "LOCATION",
"city": "Bowie",
"state": "MD",
"postal_code": "207154411",
"country_code": "US",
"telephone_number": "415-424-4266",
"fax_number": "415-520-6633",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GUTIERREZ",
"first_name": "VANESSA",
"middle_name": "IVETTE",
"credential": "RN, PNP, CRNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-31",
"last_updated": "2024-05-15",
"certification_date": "2024-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MD",
"license": "R265873",
"primary": false
},
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "FL",
"license": "APRN11031756",
"primary": false
},
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "CA",
"license": "95009713",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100366410",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Truckee, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.