Healthcare Provider Details

I. General information

NPI: 1316067200
Provider Name (Legal Business Name): JORGE H GUTIERREZ-DORRINGTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 AVE TITO CASTRO STE 101
PONCE PR
00716-0206
US

IV. Provider business mailing address

PO BOX 801089
COTO LAUREL PR
00780-1089
US

V. Phone/Fax

Practice location:
  • Phone: 787-842-2512
  • Fax: 787-840-6966
Mailing address:
  • Phone: 787-842-2512
  • Fax: 787-840-6966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number11622
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: