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General NPI Number Information
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NPI Number | 1023567997
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Entity Type | Organization
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Legal Business Name | PETER GUTIERREZ PA
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Dates
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Enumeration Date | 10/03/2016
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Last Update Date | 10/03/2016
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Provider Practice Location Address
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Address Line | 5040 NW 7TH ST STE 370
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City | MIAMI
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State | FL
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Zip | 33126-3431
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Country | US
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Telephone | 305-444-7121
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Fax | 305-735-5062
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Provider Business Mailing Address
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Address Line | 10271 SW 72ND ST # D102
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City | MIAMI
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State | FL
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Zip | 33173-3024
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Country | US
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Telephone | 305-989-9844
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Fax | 305-735-5062
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Authorized Official
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Title or Position | VP
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Name | VIVIAN GUTIERREZ
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Credential |
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Telephone | 305-989-9844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN296
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License Number State | FL
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