Provider Demographics
NPI:1235746017
Name:GUTIERREZ, EILER
Entity Type:Individual
Prefix:
First Name:EILER
Middle Name:
Last Name:GUTIERREZ
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 304
Mailing Address - Street 2:
Mailing Address - City:SILVANA
Mailing Address - State:WA
Mailing Address - Zip Code:98287-0304
Mailing Address - Country:US
Mailing Address - Phone:360-333-2137
Mailing Address - Fax:360-246-5847
Practice Address - Street 1:16019 122ND AVE NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-6638
Practice Address - Country:US
Practice Address - Phone:360-333-2137
Practice Address - Fax:360-246-5847
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC56546171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter