Healthcare Provider Details

I. General information

NPI: 1114925427
Provider Name (Legal Business Name): JUANA MARIA GUTIERREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14285 SW 42ND ST STE 205
MIAMI FL
33175-6416
US

IV. Provider business mailing address

321 OPA LOCKA BLVD
OPA LOCKA FL
33054-3526
US

V. Phone/Fax

Practice location:
  • Phone: 305-551-2165
  • Fax: 786-621-7812
Mailing address:
  • Phone: 786-476-3333
  • Fax: 786-476-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME84846
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: