Provider Demographics
NPI:1184647901
Name:GUTIERREZ COLON, JOSE R
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:R
Last Name:GUTIERREZ COLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 622
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-0622
Mailing Address - Country:US
Mailing Address - Phone:787-735-7129
Mailing Address - Fax:787-735-1679
Practice Address - Street 1:CARR 7722 KM 5.6 LA SIERRA
Practice Address - Street 2:BOX 622
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-0622
Practice Address - Country:US
Practice Address - Phone:787-735-7129
Practice Address - Fax:787-735-1679
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 230171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor