Healthcare Provider Details

I. General information

NPI: 1841413895
Provider Name (Legal Business Name): DR. HUMBERTO GUTIERREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S SEMORAN BLVD SUITE 150
ORLANDO FL
32807-3293
US

IV. Provider business mailing address

150 S SEMORAN BLVD SUITE 150
ORLANDO FL
32807-3293
US

V. Phone/Fax

Practice location:
  • Phone: 407-208-1384
  • Fax: 407-208-1385
Mailing address:
  • Phone: 407-208-1384
  • Fax: 407-208-1385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberBUS-0011178
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: