Provider Demographics
NPI:1053838862
Name:DANIEL E GUTIERREZ DO PLLC
Entity Type:Organization
Organization Name:DANIEL E GUTIERREZ DO PLLC
Other - Org Name:DANIEL E. GUTIERREZ D.O. PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARET
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:VALENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-579-3396
Mailing Address - Street 1:PO BOX 12638
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-0638
Mailing Address - Country:US
Mailing Address - Phone:210-579-3396
Mailing Address - Fax:844-485-5407
Practice Address - Street 1:1200 BROOKLYN AVE STE 130
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4810
Practice Address - Country:US
Practice Address - Phone:210-579-3396
Practice Address - Fax:844-485-5407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX395396001Medicaid