Provider Demographics
NPI:1003694928
Name:GUTIERREZ JUAREZ, MARIA MINERVA (LMT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:MINERVA
Last Name:GUTIERREZ JUAREZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 WEST LOOP S STE 150
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2915
Mailing Address - Country:US
Mailing Address - Phone:713-503-3194
Mailing Address - Fax:
Practice Address - Street 1:6300 WEST LOOP S STE 150
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2915
Practice Address - Country:US
Practice Address - Phone:713-503-3194
Practice Address - Fax:866-872-9664
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT107139225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist