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General NPI Number Information
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NPI Number | 1184647901
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Entity Type | Individual
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Provider Name | MR. JOSE R GUTIERREZ COLON
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | CARR 7722 KM 5.6 LA SIERRA BOX 622
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City | AIBONITO
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State | PR
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Zip | 00705-0622
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Country | US
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Telephone | 787-735-7129
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Fax | 787-735-1679
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Provider Business Mailing Address
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Address Line | PO BOX 622
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City | AIBONITO
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State | PR
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Zip | 00705-0622
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Country | US
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Telephone | 787-735-7129
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Fax | 787-735-1679
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | TC AMB 230
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License Number State | PR
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