=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578104931
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OSCAR A GUTIERREZ
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2019
-----------------------------------------------------
Last Update Date | 01/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR. 156 KM 48.3 BO. MULAS
-----------------------------------------------------
City | AGUAS BUENAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-528-2018
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 40
-----------------------------------------------------
City | AGUAS BUENAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00703-0040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-528-2018
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIR010279
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 000784
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------