MEDICARE: MRS. ALEXA GUTIERREZ DE PINERES B.S.-SLPA

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	2355S0801X	Speech-Language Assistant		FL

General Provider Information

NPI Number	:	1912503517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALEXA GUTIERREZ DE PINERES B.S.-SLPA

Provider Business Mailing Address
First Line	:	4265 SUNNY BROOK WAY APT 105
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-6618
Country	:	US
Telephone Number	:	407-350-8638
Fax Number	:

Provider Business Practice Location Address
First Line	:	4265 SUNNY BROOK WAY APT 105
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-6618
Country	:	US
Telephone Number	:	407-350-8638
Fax Number	:

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

Provider Enumeration Date	:	12/09/2020
Last Update Date	:	01/15/2021

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