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General NPI Number Information
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NPI Number | 1811777568
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Entity Type | Organization
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Legal Business Name | CARLOS GUTIERREZ PLLC
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 04/04/2024
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Provider Practice Location Address
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Address Line | 700 W CAMPBELL AVE STE 15
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City | PHOENIX
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State | AZ
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Zip | 85013-2691
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Country | US
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Telephone | 623-349-1392
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Fax |
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Provider Business Mailing Address
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Address Line | 700 W CAMPBELL AVE STE 15
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City | PHOENIX
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State | AZ
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Zip | 85013-2691
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN ASSISTANT
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Name | MR. LUIS CARLOS GUTIERREZ
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Credential | PA-C
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Telephone | 623-873-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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