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General NPI Number Information
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NPI Number | 1275964603
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Entity Type | Organization
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Legal Business Name | GUTIERREZ MEDICAL GROUP
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Dates
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Enumeration Date | 12/11/2013
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Last Update Date | 12/11/2013
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Provider Practice Location Address
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Address Line | 6121 HILLCROFT ST STE 0
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City | HOUSTON
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State | TX
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Zip | 77081-1002
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Country | US
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Telephone | 713-541-0064
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Fax | 713-541-0686
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Provider Business Mailing Address
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Address Line | 6121 HILLCROFT ST STE 0
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City | HOUSTON
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State | TX
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Zip | 77081-1002
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Country | US
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Telephone | 713-541-0064
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Fax | 713-541-0686
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JAIME GUTIERREZ
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Credential | MD
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Telephone | 713-541-0064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | D2109
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License Number State | TX
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