Provider Demographics
NPI:1144591314
Name:GUTIERREZ, MERCEDES A
Entity Type:Individual
Prefix:MS
First Name:MERCEDES
Middle Name:A
Last Name:GUTIERREZ
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 1:1162 W 19TH ST
Mailing Address - Street 2:APT 4
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-3392
Mailing Address - Country:US
Mailing Address - Phone:773-742-7023
Mailing Address - Fax:
Practice Address - Street 1:1162 W 19TH ST
Practice Address - Street 2:APT 4
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3392
Practice Address - Country:US
Practice Address - Phone:773-742-7023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILG36254083756171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter