Doctor Name: | GUSTAVO GUTIERREZ |
NPI Number: | 1700242112 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | AP129867 |
Business Practice Address: | 800 S County Line Dr Chaparral, NM - 880817830 |
Business Phone Number: | 5758240820 |
Business Fax Number: | 5758241021 |
Mailing Address: | 385 Calle De Alegra, Bldg. A LAS CRUCES |
State: | NM |
Postal Code: | 880053423 |
Phone Number: | 5755261105 |
Fax Number: | 5755244266 |
NPI Enumeration Date: | 01/14/2016 |
NPI Last Update Date: | 04/25/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | AP129867 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |