Healthcare Provider Details

I. General information

NPI: 1508780834
Provider Name (Legal Business Name): MELISSA ALEXANDRA GUTIERREZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

IV. Provider business mailing address

19590 NW 84TH AVE
HIALEAH FL
33015-5940
US

V. Phone/Fax

Practice location:
  • Phone: 305-669-6503
  • Fax:
Mailing address:
  • Phone: 305-669-6503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY13300
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: