Healthcare Provider Details

I. General information

NPI: 1083605380
Provider Name (Legal Business Name): LILIANA D GUTIERREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-1141
US

IV. Provider business mailing address

PO BOX 100296
GAINESVILLE FL
32610-1141
US

V. Phone/Fax

Practice location:
  • Phone: 352-294-5252
  • Fax: 352-294-8068
Mailing address:
  • Phone: 352-294-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01051753
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberME73788
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: