MEDICARE: MR. MANUEL ANTONIO GUTIERREZ HERNANDEZ SR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1215918115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MANUEL ANTONIO GUTIERREZ HERNANDEZ SR. MD

Provider Business Mailing Address
First Line	:	PO BOX 112
Second Line	:	BARBOSA AVE #209
City	:	LAS PIEDRAS
State	:	PR
Zip	:	00771
Country	:	US
Telephone Number	:	787-733-0220
Fax Number	:	787-716-0190

Provider Business Practice Location Address
First Line	:	JOSE C BARBOSA AVE #209
Second Line	:
City	:	LAS PIEDRAS
State	:	PR
Zip	:	00771
Country	:	US
Telephone Number	:	787-733-0220
Fax Number	:	787-716-0190

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	04/04/2016

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