Healthcare Provider Details

I. General information

NPI: 1669712196
Provider Name (Legal Business Name): LUIS F GUTIERREZ MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9690 W SAMPLE RD STE 101-102
CORAL SPRINGS FL
33065-4046
US

IV. Provider business mailing address

9690 W SAMPLE RD STE 101-102
CORAL SPRINGS FL
33065-4046
US

V. Phone/Fax

Practice location:
  • Phone: 954-346-8800
  • Fax: 954-346-8280
Mailing address:
  • Phone: 954-346-8800
  • Fax: 954-346-8280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LUIS F GUTIERREZ
Title or Position: OWNER
Credential: MD
Phone: 954-346-8800