Provider Demographics
NPI:1114925427
Name:GUTIERREZ, JUANA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:JUANA
Middle Name:MARIA
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:321 OPA LOCKA BLVD
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-3526
Mailing Address - Country:US
Mailing Address - Phone:786-476-3333
Mailing Address - Fax:786-476-3334
Practice Address - Street 1:14285 SW 42ND ST STE 205
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6416
Practice Address - Country:US
Practice Address - Phone:305-551-2165
Practice Address - Fax:786-621-7812
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84846208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272185600Medicaid
FL272185600Medicaid