Healthcare Provider Details

I. General information

NPI: 1205931128
Provider Name (Legal Business Name): ERNEST D GUTIERREZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 MEDICO LANE SUITE C
SANTA FE NM
87505
US

IV. Provider business mailing address

422 MEDICO LANE SUITE C
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-4829
  • Fax: 505-983-2781
Mailing address:
  • Phone: 505-988-4829
  • Fax: 505-983-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number466
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: