Healthcare Provider Details

I. General information

NPI: 1417891102
Provider Name (Legal Business Name): ALEXIS MERCEDES GUTIERREZ
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: LEX GUTIERREZ

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DODGE AVE
EVANSTON IL
60201-3449
US

IV. Provider business mailing address

3645 W ARMITAGE AVE APT 3
CHICAGO IL
60647-3661
US

V. Phone/Fax

Practice location:
  • Phone: 713-449-7568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: