Healthcare Provider Details

I. General information

NPI: 1003321530
Provider Name (Legal Business Name): REBECCA GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 GILBERT AVE S
LEHIGH ACRES FL
33973-2670
US

IV. Provider business mailing address

1511 GILBERT AVE S
LEHIGH ACRES FL
33973-2670
US

V. Phone/Fax

Practice location:
  • Phone: 786-991-6198
  • Fax:
Mailing address:
  • Phone: 786-991-6198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: