Provider Demographics
NPI:1164827325
Name:GUTIERREZ, CRISTIAN (CSA)
Entity Type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7611 LITTLE RIVER TPKE
Mailing Address - Street 2:101-E
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2611
Mailing Address - Country:US
Mailing Address - Phone:703-256-2307
Mailing Address - Fax:703-256-3230
Practice Address - Street 1:7611 LITTLE RIVER TPKE
Practice Address - Street 2:101-E
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2611
Practice Address - Country:US
Practice Address - Phone:703-256-2307
Practice Address - Fax:703-256-3230
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant