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General NPI Number Information
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NPI Number | 1427437151
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Entity Type | Individual
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Provider Name | JACQUELINE GUTIERREZ MD
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Gender | Female
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Dates
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Enumeration Date | 05/27/2015
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 221 3RD ST W BLDG 1040
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City | JBSA RANDOLPH
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State | TX
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Zip | 78150-4800
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Country | US
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Telephone | 210-652-4267
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Fax |
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Provider Business Mailing Address
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Address Line | 221 3RD ST W BLDG 1040
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City | JBSA RANDOLPH
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State | TX
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Zip | 78150-4800
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Country | US
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Telephone | 210-652-4267
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 30128
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 30128
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License Number State | NE
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