Healthcare Provider Details

I. General information

NPI: 1659892693
Provider Name (Legal Business Name): JUAN CARLOS MOISES GUTIERREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 SW 27TH AVE
MIAMI FL
33145-1252
US

IV. Provider business mailing address

8400 NW 33RD ST STE 201
DORAL FL
33122-1937
US

V. Phone/Fax

Practice location:
  • Phone: 844-665-4827
  • Fax:
Mailing address:
  • Phone: 844-665-4827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number14443-I
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1171
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: