Provider Demographics
NPI:1033427554
Name:GUTIERREZ, MELINDA (PA)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:15571 N REEMS RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-9584
Mailing Address - Country:US
Mailing Address - Phone:623-544-6932
Mailing Address - Fax:623-321-1070
Practice Address - Street 1:15571 N REEMS RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-9584
Practice Address - Country:US
Practice Address - Phone:623-544-6932
Practice Address - Fax:623-321-1070
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2014-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ4701363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant