Healthcare Provider Details

I. General information

NPI: 1285543736
Provider Name (Legal Business Name): ROGER ABRAHAM ZALDIVAR GUTIERREZ SR. FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 NE 2ND DR
HOMESTEAD FL
33033-3037
US

IV. Provider business mailing address

2902 NE 2ND DR
HOMESTEAD FL
33033-3037
US

V. Phone/Fax

Practice location:
  • Phone: 786-837-1115
  • Fax: 786-837-1115
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11050226
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: