Provider Demographics
NPI:1073587267
Name:GUTIERREZ, JORGE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:L
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1074 CALLE GUAJATACA
Mailing Address - Street 2:URB. VALLES DEL LAGO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-7635
Mailing Address - Country:US
Mailing Address - Phone:787-613-0525
Mailing Address - Fax:787-286-0661
Practice Address - Street 1:1074 CALLE GUAJATACA
Practice Address - Street 2:URB. VALLES DEL LAGO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-7635
Practice Address - Country:US
Practice Address - Phone:787-613-0525
Practice Address - Fax:787-286-0661
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR11092207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine