Provider Demographics
NPI:1043416712
Name:GUTIERREZ, RAMON (AP)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4904 S CLYDE MORRIS BLVD
Mailing Address - Street 2:STE D2
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-4170
Mailing Address - Country:US
Mailing Address - Phone:386-898-0908
Mailing Address - Fax:386-898-0242
Practice Address - Street 1:4904 S CLYDE MORRIS BLVD
Practice Address - Street 2:STE D2
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-4170
Practice Address - Country:US
Practice Address - Phone:386-898-0908
Practice Address - Fax:386-898-0242
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2096171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1720155997OtherGROUP NPI
FLC2977OtherBCBS ACU # RAMON
FLY923LOtherBCBS FACILITY # PO
FLY926BOtherBCBS FACILITY # OB
FLY923DOtherBCBS FACILITY # OC
FLY923DOtherBCBS FACILITY # OC