MEDICARE: MARIANA RENE 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	1179131	TX

General Provider Information

NPI Number	:	1699589838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANA RENE GUTIERREZ NP

Provider Business Mailing Address
First Line	:	716 WAUGH DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-2033
Country	:	US
Telephone Number	:	832-212-7232
Fax Number	:

Provider Business Practice Location Address
First Line	:	12333 MAIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77035-6205
Country	:	US
Telephone Number	:	713-729-7600
Fax Number	:

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

Provider Enumeration Date	:	02/06/2025
Last Update Date	:	02/27/2025

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