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General NPI Number Information
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NPI Number | 1215799556
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Entity Type | Individual
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Provider Name | LUIS MIGUEL GUTIERREZ
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Gender | Male
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Dates
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Enumeration Date | 01/23/2024
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Last Update Date | 05/14/2024
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Provider Practice Location Address
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Address Line | 318 KNICKERBOCKER AVE
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City | BROOKLYN
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State | NY
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Zip | 11237-3888
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Country | US
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Telephone | 718-765-6056
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Fax | 347-803-1874
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Provider Business Mailing Address
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Address Line | PO BOX 746087
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City | ATLANTA
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State | GA
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Zip | 30374-6087
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Country | US
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Telephone | 312-733-9730
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Fax |
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 26NJ14990800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 311655
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License Number State | NY
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