Healthcare Provider Details

I. General information

NPI: 1962171454
Provider Name (Legal Business Name): EMILY PAMELA QUISPE GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W 50TH ST
HIALEAH FL
33012-3440
US

IV. Provider business mailing address

6484 E 6TH AVE
HIALEAH FL
33013-1126
US

V. Phone/Fax

Practice location:
  • Phone: 305-231-3371
  • Fax:
Mailing address:
  • Phone: 305-305-1560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ13391
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: