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General NPI Number Information
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NPI Number | 1912999301
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Entity Type | Individual
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Provider Name | GUILLERMO GUTIERREZ MD
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Gender | Male
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 530 NEW BRUNSWICK AVE
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City | PERTH AMBOY
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State | NJ
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Zip | 08861-3654
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Country | US
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Telephone | 732-324-6031
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Fax | 732-324-4811
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Provider Business Mailing Address
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Address Line | PO BOX 48270
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City | NEWARK
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State | NJ
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Zip | 07101-8470
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Country | US
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Telephone | 201-818-9118
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MA05749600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 25MA05749600
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License Number State | NJ
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