Provider Demographics
NPI:1174183099
Name:GUTIERREZ, PAULINA MONTSERRAT
Entity Type:Individual
Prefix:
First Name:PAULINA
Middle Name:MONTSERRAT
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 1:5319 EVERGREEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-3064
Mailing Address - Country:US
Mailing Address - Phone:713-351-9846
Mailing Address - Fax:
Practice Address - Street 1:22710 PROFESSIONAL DR STE 203
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-6009
Practice Address - Country:US
Practice Address - Phone:281-312-8530
Practice Address - Fax:281-719-5916
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143331363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily