Healthcare Provider Details

I. General information

NPI: 1760828172
Provider Name (Legal Business Name): DAVID EMMANUEL GUTIERREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOWARD AVE FL 1
NEW HAVEN CT
06519
US

IV. Provider business mailing address

PO BOX 208071
NEW HAVEN CT
06520-8071
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4949
  • Fax:
Mailing address:
  • Phone: 203-785-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number62247
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: