Provider Demographics
NPI:1255693313
Name:GUTIERREZ HOLISTIC FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:GUTIERREZ HOLISTIC FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ORESTES
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:541-232-5627
Mailing Address - Street 1:3575 DONALD ST
Mailing Address - Street 2:SUITE 110 A & B
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4753
Mailing Address - Country:US
Mailing Address - Phone:458-205-5907
Mailing Address - Fax:154-131-9722
Practice Address - Street 1:3575 DONALD ST
Practice Address - Street 2:SUITE 110
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-4753
Practice Address - Country:US
Practice Address - Phone:458-205-5907
Practice Address - Fax:154-131-9722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO152080261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care