MEDICARE: JAZMIN IVETTE GUTIERREZ

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	106S00000X	Behavior Technician	RBT-25-446923	TX

General Provider Information

NPI Number	:	1528950060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAZMIN IVETTE GUTIERREZ

Provider Business Mailing Address
First Line	:	3304 CHICKASAW DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-1391
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3304 CHICKASAW DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-1391
Country	:	US
Telephone Number	:	915-274-2035
Fax Number	:

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

Provider Enumeration Date	:	07/18/2025
Last Update Date	:	07/18/2025

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