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General NPI Number Information
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NPI Number | 1144336389
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Entity Type | Organization
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Legal Business Name | GUTIERREZ, MARIO A MD PA
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 313 W. COUNTRY CLUB RD STE 14
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City | ROSWELL
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State | NM
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Zip | 88201
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Country | US
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Telephone | 575-625-0977
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Fax | 575-625-1027
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Provider Business Mailing Address
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Address Line | 313 W. COUNTRY CLUB RD STE 14
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City | ROSWELL
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State | NM
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Zip | 88201
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Country | US
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Telephone | 575-625-0977
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Fax | 575-625-1027
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ELSA GUTIERREZ
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Credential |
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Telephone | 575-625-0977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 91-213
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License Number State | NM
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