Healthcare Provider Details

I. General information

NPI: 1609143460
Provider Name (Legal Business Name): RAUL GUTIERREZ ACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 ELECTRIC RD
SALEM VA
24153-7474
US

IV. Provider business mailing address

2609 PORTLAND AVE
EL PASO TX
79930-2811
US

V. Phone/Fax

Practice location:
  • Phone: 540-776-4099
  • Fax:
Mailing address:
  • Phone: 617-352-5043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024188097
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024188097
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP121166
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024188097
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number86651
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number747453
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: