Healthcare Provider Details

I. General information

NPI: 1134578677
Provider Name (Legal Business Name): DR. RENEE GUTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5715 N CALLE DE LUCIMIENTO
TUCSON AZ
85718-5134
US

IV. Provider business mailing address

5715 N CALLE DE LUCIMIENTO
TUCSON AZ
85718-5134
US

V. Phone/Fax

Practice location:
  • Phone: 520-299-1224
  • Fax: 520-299-2208
Mailing address:
  • Phone: 520-299-1224
  • Fax: 520-299-2208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3678
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number011178-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: