Healthcare Provider Details

I. General information

NPI: 1669449773
Provider Name (Legal Business Name): M. NIEVES EUSEBIO GUTIERREZ-GO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80495 US HIGHWAY 111
INDIO CA
92201-6534
US

IV. Provider business mailing address

80495 US HIGHWAY 111
INDIO CA
92201-6534
US

V. Phone/Fax

Practice location:
  • Phone: 760-347-2887
  • Fax: 760-347-0776
Mailing address:
  • Phone: 760-347-2887
  • Fax: 760-347-0776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA51819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: