Provider Demographics
NPI:1336142074
Name:GUTIERREZ, HERIBERTO G (MD)
Entity Type:Individual
Prefix:
First Name:HERIBERTO
Middle Name:G
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 S 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85723-0001
Mailing Address - Country:US
Mailing Address - Phone:520-792-1450
Mailing Address - Fax:
Practice Address - Street 1:3601 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723-3533
Practice Address - Country:US
Practice Address - Phone:520-792-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-25
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24156207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ10044506OtherPPO NEXT
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AZ14716OtherARIZONA MEDICAL NETWORK
AZ25-00276OtherUNITED HEALTHCARE
AZ5073464OtherCCN
AZAZ0860280OtherBCBS OF ARIZONA
AZ005502490OtherCIGNA
AZ102609OtherPREFERRED HEALTH NETWORK
AZ100644OtherONE HEALTH
AZ5278173OtherAETNA
AZ060057022OtherRAILROAD MEDICARE
AZ346826Medicaid
AZ1Z3635OtherHEALTH NET
AZ933771OtherFIRST HEALTH
CAXPY197813OtherMEDI-CAL
AZ5278173OtherAETNA
AZ346826Medicaid
139764Medicare PIN
AZZ102585Medicare PIN
AZZ29516Medicare PIN
AZ5073464OtherCCN