Healthcare Provider Details

I. General information

NPI: 1952380776
Provider Name (Legal Business Name): ARTURO GUTIERREZ III PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 GEORGE DIETER DR SUITE 100
EL PASO TX
79936-7653
US

IV. Provider business mailing address

PO BOX 12793
EL PASO TX
79913-0793
US

V. Phone/Fax

Practice location:
  • Phone: 915-581-0712
  • Fax: 915-833-7312
Mailing address:
  • Phone: 915-581-0712
  • Fax: 915-833-7312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA004449
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: