Doctor Name: | MR. NICHOLAS RAYMOND GUTIERREZ |
NPI Number: | 1073977625 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | ATC, LAT |
License Number: | 587 |
Business Practice Address: | 1776 Emilio Lopez Rd Nw Los Lunas, NM - 870317082 |
Business Phone Number: | 5058654646 |
Business Fax Number: | |
Mailing Address: | 1776 Emilio Lopez Rd Nw, LOS LUNAS |
State: | NM |
Postal Code: | 870317082 |
Phone Number: | 5058654646 |
Fax Number: | |
NPI Enumeration Date: | 04/11/2016 |
NPI Last Update Date: | 04/11/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 587 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |