Provider Demographics
NPI:1194033308
Name:GUTERMAN, EVISA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:EVISA
Middle Name:
Last Name:GUTERMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EVISA
Other - Middle Name:
Other - Last Name:PESHTANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3850 BIRD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1521
Mailing Address - Country:US
Mailing Address - Phone:305-448-9100
Mailing Address - Fax:305-448-1050
Practice Address - Street 1:3850 BIRD RD STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33146-1521
Practice Address - Country:US
Practice Address - Phone:305-448-9100
Practice Address - Fax:305-448-1050
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2023-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA-9114739OtherSTATE OF FLORIDA PHYSICIAN ASSISTANT LICENSE