Healthcare Provider Details

I. General information

NPI: 1740238468
Provider Name (Legal Business Name): BERNARDO A GUTIERREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14075 TOWN LOOP BLVD
ORLANDO FL
32837-6132
US

IV. Provider business mailing address

PO BOX 616788
ORLANDO FL
32861-6788
US

V. Phone/Fax

Practice location:
  • Phone: 407-438-5858
  • Fax: 407-387-1724
Mailing address:
  • Phone: 407-533-6837
  • Fax: 407-770-0661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME141745
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: