MEDICARE: CARLOS 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	310400000X	Assisted Living Facility
2	310400000X	Assisted Living Facility		FL

General Provider Information

NPI Number	:	1821518960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS GUTIERREZ

Provider Business Mailing Address
First Line	:	5613 HALIFAX DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4118
Country	:	US
Telephone Number	:	813-833-6700
Fax Number	:

Provider Business Practice Location Address
First Line	:	8233 DRYCREEK DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-1207
Country	:	US
Telephone Number	:	813-833-6700
Fax Number	:

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

Provider Enumeration Date	:	06/20/2017
Last Update Date	:	06/20/2017

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Directions to “ CARLOS GUTIERREZ ” Practice Location

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