Provider Demographics
NPI:1346253317
Name:GUTIERREZ JOVET, SIRO J (DC)
Entity Type:Individual
Prefix:DR
First Name:SIRO
Middle Name:J
Last Name:GUTIERREZ JOVET
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6234
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-6234
Mailing Address - Country:US
Mailing Address - Phone:787-805-2445
Mailing Address - Fax:787-805-2445
Practice Address - Street 1:2599 AVE HOSTOS
Practice Address - Street 2:SUITE 10
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-6400
Practice Address - Country:US
Practice Address - Phone:787-805-2445
Practice Address - Fax:787-805-2445
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRW-01073Medicare UPIN
PRHP379AMedicare PIN