=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477766566
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GUTIERREZ MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2007
-----------------------------------------------------
Last Update Date | 08/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 122 W CHAMPION ST
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78539-4429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-287-1207
-----------------------------------------------------
Fax | 956-287-1292
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 122 W CHAMPION ST
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78539-4429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-287-1207
-----------------------------------------------------
Fax | 956-287-1292
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DOCTOR
-----------------------------------------------------
Name | DR. ALBERTO H GUTIERREZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 956-287-1207
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | D3247
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------