Healthcare Provider Details

I. General information

NPI: 1508946401
Provider Name (Legal Business Name): NANCY MARIA GUTIERREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 COLLINS AVE
MIAMI BEACH FL
33139-6213
US

IV. Provider business mailing address

1756 N BAYSHORE DR APT 26B
MIAMI FL
33132-2720
US

V. Phone/Fax

Practice location:
  • Phone: 305-535-5540
  • Fax: 305-535-5543
Mailing address:
  • Phone: 786-423-6889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME0043282
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: