MEDICARE: DR. HUMBERTO 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	111NR0400X	Rehabilitation Chiropractor	BUS-0011178	FL

General Provider Information

NPI Number	:	1841413895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HUMBERTO GUTIERREZ

Provider Business Mailing Address
First Line	:	150 S SEMORAN BLVD
Second Line	:	SUITE 150
City	:	ORLANDO
State	:	FL
Zip	:	32807-3293
Country	:	US
Telephone Number	:	407-208-1384
Fax Number	:	407-208-1385

Provider Business Practice Location Address
First Line	:	150 S SEMORAN BLVD
Second Line	:	SUITE 150
City	:	ORLANDO
State	:	FL
Zip	:	32807-3293
Country	:	US
Telephone Number	:	407-208-1384
Fax Number	:	407-208-1385

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	10/01/2007

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