MEDICARE: RAFAEL A 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1801145669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAEL A GUTIERREZ

Provider Business Mailing Address
First Line	:	937 CALLE DURBEC
Second Line	:	URB COUNTRY CLUB
City	:	SAN JUAN
State	:	PR
Zip	:	00924-3377
Country	:	US
Telephone Number	:	787-598-7116
Fax Number	:	787-753-6443

Provider Business Practice Location Address
First Line	:	COND PARK CT
Second Line	:	EDIFICIO V PFIZER TOWER SUIT 301
City	:	SAN JUAN
State	:	PR
Zip	:	00926-2229
Country	:	US
Telephone Number	:	787-641-0773
Fax Number	:

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

Provider Enumeration Date	:	09/07/2012
Last Update Date	:	09/07/2012

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Directions to “ RAFAEL A GUTIERREZ ” Practice Location

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