MEDICARE: GASTON ALBA GUTIERREZ NP

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	363LF0000X	Family Nurse Practitioner	01771	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275695538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GASTON ALBA GUTIERREZ NP

Provider Business Mailing Address
First Line	:	85 WEST HIGHWAY 22
Second Line	:
City	:	SANTO DOMINGO
State	:	NM
Zip	:	87052
Country	:	US
Telephone Number	:	505-464-3060
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 MONTANO RD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-5743
Country	:	US
Telephone Number	:	505-866-3892
Fax Number	:

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	03/07/2023

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