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General NPI Number Information
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NPI Number | 1669514808
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Entity Type | Organization
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Legal Business Name | GUTIERREZ & FAXAS, P.A.
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10000 W SAMPLE RD
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-3936
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Country | US
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Telephone | 954-346-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 10000 W SAMPLE RD
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-3936
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Country | US
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Telephone | 954-346-8800
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Fax |
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Authorized Official
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Title or Position | PRES.
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Name | GIL F GUTIERREZ
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Credential | M.D.
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Telephone | 954-346-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME52075
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License Number State | FL
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