Provider Demographics
NPI:1033662150
Name:GUTIERREZ, STEPHANIE ROXANA
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ROXANA
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 RICHMOND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3937
Mailing Address - Country:US
Mailing Address - Phone:180-031-4807
Mailing Address - Fax:
Practice Address - Street 1:2025 RICHMOND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3937
Practice Address - Country:US
Practice Address - Phone:180-031-4807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist