Healthcare Provider Details

I. General information

NPI: 1316922016
Provider Name (Legal Business Name): LILIANA GUTIERREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E VENICE AVE FL 1
VENICE FL
34292-3190
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 941-483-9700
  • Fax: 941-483-9715
Mailing address:
  • Phone: 877-856-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME73303
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: