Healthcare Provider Details

I. General information

NPI: 1811777568
Provider Name (Legal Business Name): CARLOS GUTIERREZ PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W CAMPBELL AVE STE 15
PHOENIX AZ
85013-2691
US

IV. Provider business mailing address

700 W CAMPBELL AVE STE 15
PHOENIX AZ
85013-2691
US

V. Phone/Fax

Practice location:
  • Phone: 623-349-1392
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. LUIS CARLOS GUTIERREZ
Title or Position: PRESIDENT/PHYSICIAN ASSISTANT
Credential: PA-C
Phone: 623-873-1200