Provider Demographics
NPI:1295224079
Name:MANENT GUTIERREZ, ANIET (MD)
Entity Type:Individual
Prefix:
First Name:ANIET
Middle Name:
Last Name:MANENT GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10794 N KENDALL DR APT B2
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1418
Mailing Address - Country:US
Mailing Address - Phone:786-803-5363
Mailing Address - Fax:
Practice Address - Street 1:1475 W 49TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3113
Practice Address - Country:US
Practice Address - Phone:305-558-2500
Practice Address - Fax:786-456-8404
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FLACN1523208D00000X
FLTRN374162081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative Medicine
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023316200Medicaid