Healthcare Provider Details

I. General information

NPI: 1497105142
Provider Name (Legal Business Name): GERARDO LORENZO GUTIEREZ RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 N. PIEDRAS US ARMY DENTAL ACTIVITY
EL PASO TX
79920-5001
US

IV. Provider business mailing address

5005 N. PIEDRAS US ARMY DENTAL ACTIVITY
EL PASO TX
79920-5001
US

V. Phone/Fax

Practice location:
  • Phone: 915-742-2511
  • Fax:
Mailing address:
  • Phone: 915-742-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number643158
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: