Provider Demographics
NPI:1023378841
Name:GUTIERREZ, LUIS BALMORE (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:BALMORE
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:177 N HUDSON AVE UNIT 314
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2295
Mailing Address - Country:US
Mailing Address - Phone:562-652-6565
Mailing Address - Fax:
Practice Address - Street 1:100 W CALIFORNIA BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105
Practice Address - Country:US
Practice Address - Phone:626-397-5139
Practice Address - Fax:626-397-2190
Is Sole Proprietor?:No
Enumeration Date:2012-05-26
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1294782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology