Healthcare Provider Details

I. General information

NPI: 1518944636
Provider Name (Legal Business Name): MIGUELA TALAVERA GUTIERREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MCDONALD ARMY COMMUNITY HOSPITAL BLDG 576
FT EUSTIS VA
23604
US

IV. Provider business mailing address

509 THOMAS BRANSBY
WILLIAMSBURG VA
23185-8244
US

V. Phone/Fax

Practice location:
  • Phone: 575-314-7682
  • Fax: 757-314-7511
Mailing address:
  • Phone: 757-314-7682
  • Fax: 757-314-7511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101026126
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: