Healthcare Provider Details

I. General information

NPI: 1629280342
Provider Name (Legal Business Name): RAMON LUIS GUTIERREZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONDOMINIO EL CENTRO II 500 MUNOZ RIVERA AVENUE SUITE 225
HATO REY PR
00918
US

IV. Provider business mailing address

LOS CAMPOS DE MONTEHIEDRA 785
SAN JUAN PR
00926-7033
US

V. Phone/Fax

Practice location:
  • Phone: 787-274-2600
  • Fax: 787-751-7964
Mailing address:
  • Phone: 787-415-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number11159
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: