Healthcare Provider Details

I. General information

NPI: 1144877218
Provider Name (Legal Business Name): DIANA LEE GUTIERREZ AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 GOLF COURSE RD SE STE 109
RIO RANCHO NM
87124-4705
US

IV. Provider business mailing address

1016 QUINTA ANTIGUA LN
EL PASO TX
79912-2039
US

V. Phone/Fax

Practice location:
  • Phone: 505-891-3344
  • Fax: 505-896-4499
Mailing address:
  • Phone: 915-779-7378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberC-APN.0101302-C-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number56997
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number56997
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number56997
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: