MEDICARE: RAMON GUTIERREZ A.P.

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
1	171100000X	Acupuncturist	AP2096	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1720155997	OTHER	FL	GROUP NPI
2	C2977	OTHER	FL	BCBS ACU # RAMON
3	Y923L	OTHER	FL	BCBS FACILITY # PO
4	Y926B	OTHER	FL	BCBS FACILITY # OB
5	Y923D	OTHER	FL	BCBS FACILITY # OC
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043416712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMON GUTIERREZ A.P.

Provider Business Mailing Address
First Line	:	4904 S CLYDE MORRIS BLVD
Second Line	:	STE D2
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-4170
Country	:	US
Telephone Number	:	386-898-0908
Fax Number	:	386-898-0242

Provider Business Practice Location Address
First Line	:	4904 S CLYDE MORRIS BLVD
Second Line	:	STE D2
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-4170
Country	:	US
Telephone Number	:	386-898-0908
Fax Number	:	386-898-0242

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	07/08/2007

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Directions to “ RAMON GUTIERREZ A.P.” Practice Location

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