Healthcare Provider Details

I. General information

NPI: 1013362953
Provider Name (Legal Business Name): JASMINE GUTIERREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JASMINE NANEZ

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6727 ACADEMY RD NE STE C
ALBUQUERQUE NM
87109-3369
US

IV. Provider business mailing address

6727 ACADEMY RD NE STE C
ALBUQUERQUE NM
87109-3369
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-1818
  • Fax: 505-293-2952
Mailing address:
  • Phone: 505-621-8669
  • Fax: 505-293-2952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2023-1298
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA164172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: