Healthcare Provider Details

I. General information

NPI: 1164170932
Provider Name (Legal Business Name): DAMARIS GUTIERREZ ITDS & RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8491 NW 17TH ST STE 110
DORAL FL
33126-1025
US

IV. Provider business mailing address

3250 W 9TH AVE
HIALEAH FL
33012-5010
US

V. Phone/Fax

Practice location:
  • Phone: 305-456-5542
  • Fax: 786-598-7590
Mailing address:
  • Phone: 305-794-3390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-89497
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: