Provider Demographics
NPI:1134683626
Name:GUTIERREZ-PEREZ, YARIMAR
Entity Type:Individual
Prefix:
First Name:YARIMAR
Middle Name:
Last Name:GUTIERREZ-PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5014 BOUDINOT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-4003
Mailing Address - Country:US
Mailing Address - Phone:267-506-8386
Mailing Address - Fax:
Practice Address - Street 1:1518 WALNUT ST STE 1000
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3411
Practice Address - Country:US
Practice Address - Phone:267-603-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG011594225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist