Healthcare Provider Details

I. General information

NPI: 1174630230
Provider Name (Legal Business Name): CONSTANZA J. GUTIERREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 N LAMAR BLVD
AUSTIN TX
78756-4080
US

IV. Provider business mailing address

5655 HUDSON DR STE 210 ARIS RADIOLOGY
HUDSON OH
44236-4455
US

V. Phone/Fax

Practice location:
  • Phone: 512-407-7000
  • Fax:
Mailing address:
  • Phone: 330-655-1869
  • Fax: 330-655-3828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME121936
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberL3324
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD037649
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: