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NPI Code Detail

MEDICARE: MR. DAVID GUTIERREZ PA-C

MEDICARE: MR. DAVID GUTIERREZ PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant0110840444VA

General Provider Information

NPI Number : 1033110127
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID GUTIERREZ PA-C
Provider Business Mailing Address
First Line : 2620 JANSON DR
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23321-3808
Country : US
Telephone Number : 757-488-3899
Fax Number :
Provider Business Practice Location Address
First Line : 1721 TAUSSIG BLVD
Second Line :
City : NORFOLK
State : VA
Zip : 23511
Country : US
Telephone Number : 747-314-6329
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 07/08/2007

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