Provider Demographics
NPI:1093577850
Name:CHARLES ELIAS GUTIERREZ PHD LLC
Entity Type:Organization
Organization Name:CHARLES ELIAS GUTIERREZ PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHD
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-354-1186
Mailing Address - Street 1:8401 DATAPOINT DR STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5904
Mailing Address - Country:US
Mailing Address - Phone:210-354-1186
Mailing Address - Fax:
Practice Address - Street 1:8401 DATAPOINT DR STE 301
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5904
Practice Address - Country:US
Practice Address - Phone:210-354-1186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty