Provider Demographics
NPI:1306857701
Name:GUTIERREZ, AIREEN LUGUE (MD)
Entity Type:Individual
Prefix:DR
First Name:AIREEN
Middle Name:LUGUE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3914 MURPHY CANYON RD
Mailing Address - Street 2:SUITE A150
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4491
Mailing Address - Country:US
Mailing Address - Phone:858-573-9902
Mailing Address - Fax:858-573-9906
Practice Address - Street 1:3914 MURPHY CANYON RD
Practice Address - Street 2:SUITE A150
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4491
Practice Address - Country:US
Practice Address - Phone:858-573-9902
Practice Address - Fax:858-573-9906
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAWA77031A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H49092Medicare UPIN
CAWA77031AMedicare ID - Type Unspecified