Provider Demographics
NPI:1235990144
Name:MATUTE GONZALEZ, GUILLIANA DEL CARMEN (SA/C)
Entity Type:Individual
Prefix:
First Name:GUILLIANA
Middle Name:DEL CARMEN
Last Name:MATUTE GONZALEZ
Suffix:
Gender:F
Credentials:SA/C
Other - Prefix:
Other - First Name:GIGI
Other - Middle Name:
Other - Last Name:MATUTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11431 NW 35TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-2602
Mailing Address - Country:US
Mailing Address - Phone:754-423-4451
Mailing Address - Fax:
Practice Address - Street 1:11431 NW 35TH ST
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-2602
Practice Address - Country:US
Practice Address - Phone:754-423-4451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
24-110246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant