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General NPI Number Information
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NPI Number | 1356314504
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Entity Type | Organization
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Legal Business Name | GUTIERREZ MEDICAL GROUP PA
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1010 E ROOSEVELT AVE
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City | GRANTS
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State | NM
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Zip | 87020-2118
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Country | US
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Telephone | 505-287-2948
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Fax | 505-287-5372
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Provider Business Mailing Address
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Address Line | 1010 E ROOSEVELT AVE
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City | GRANTS
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State | NM
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Zip | 87020-2118
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Country | US
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Telephone | 505-287-2948
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Fax | 505-287-5372
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MARIA ROMERO
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Credential | RHIT
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Telephone | 505-287-2948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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