MEDICARE: JULIA GUTIERREZ 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207V00000X	Obstetrics & Gynecology Physician	T0083	TX

General Provider Information

NPI Number	:	1487188165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA GUTIERREZ MD

Provider Business Mailing Address
First Line	:	12200 RENFERT WAY STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-5654
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12200 RENFERT WAY STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-5654
Country	:	US
Telephone Number	:	512-451-8211
Fax Number	:

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

Provider Enumeration Date	:	04/19/2017
Last Update Date	:	07/10/2021

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