Healthcare Provider Details

I. General information

NPI: 1003911975
Provider Name (Legal Business Name): LUIS FERNANDO GUTIERREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CORAL SPRINGS WELLNE CENTER MD

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 04/13/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9690 W SAMPLE RD STE 101
CORAL SPRINGS FL
33065-4031
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 TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME94423
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME94423
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: