Provider Demographics
NPI:1003911975
Name:GUTIERREZ, LUIS FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:FERNANDO
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CORAL SPRINGS WELLNE
Other - Middle Name:
Other - Last Name:CENTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9690 W SAMPLE RD STE 101-102
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4046
Mailing Address - Country:US
Mailing Address - Phone:954-346-8800
Mailing Address - Fax:954-346-8280
Practice Address - Street 1:9690 W SAMPLE RD STE 101
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4031
Practice Address - Country:US
Practice Address - Phone:954-346-8800
Practice Address - Fax:954-346-8280
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94423207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000052500Medicaid
FL921426220995003OtherMEDICARE
FL10D0722060OtherCLIA
FL11936941OtherCAQH
FLME94423OtherME LICENSE