MEDICARE: MISS MARGARITA C GUTIERREZ M.S., C.C.C., S.L.P.

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	235Z00000X	Speech-Language Pathologist	SA 4288	FL

General Provider Information

NPI Number	:	1750372926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARGARITA C GUTIERREZ M.S., C.C.C., S.L.P.

Provider Business Mailing Address
First Line	:	7106 HAWKS NEST TER
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33407-1126
Country	:	US
Telephone Number	:	561-845-8898
Fax Number	:	561-845-8898

Provider Business Practice Location Address
First Line	:	2555 N DIXIE HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-6250
Country	:	US
Telephone Number	:	561-585-4881
Fax Number	:	561-585-7452

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

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	07/09/2007

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