Provider Demographics
NPI:1003067885
Name:GUTIERREZ, ODIN (AP)
Entity Type:Individual
Prefix:
First Name:ODIN
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 THREE ISLANDS BLVD
Mailing Address - Street 2:APT 701
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2893
Mailing Address - Country:US
Mailing Address - Phone:786-564-1881
Mailing Address - Fax:
Practice Address - Street 1:1650 NE 26TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1431
Practice Address - Country:US
Practice Address - Phone:786-564-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2616171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist