Provider Demographics
NPI:1043078629
Name:GUTIERREZ, VICTORIA BRIANA (MPH, MPAS, PA-C)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:BRIANA
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MPH, MPAS, PA-C
Other - Prefix:
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Mailing Address - Street 1:11319 WHISPER FALLS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3539
Mailing Address - Country:US
Mailing Address - Phone:210-748-5886
Mailing Address - Fax:
Practice Address - Street 1:3500 CAMP BOWIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2644
Practice Address - Country:US
Practice Address - Phone:817-735-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant