Provider Demographics
NPI:1346231420
Name:GUTIERREZ, ALVIN L (MD)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:L
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 1:601 N FLAMINGO RD
Mailing Address - Street 2:SUITE 206A
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1015
Mailing Address - Country:US
Mailing Address - Phone:954-450-2977
Mailing Address - Fax:954-450-2504
Practice Address - Street 1:601 N FLAMINGO RD
Practice Address - Street 2:SUITE 206A
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1015
Practice Address - Country:US
Practice Address - Phone:954-450-2977
Practice Address - Fax:954-450-2504
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72322207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5036119OtherAETNA
32910OtherBCBS
FL271335700Medicaid
5036119OtherAETNA
FL271335700Medicaid