Provider Demographics
NPI:1346460532
Name:GUTIERREZ, MARIA DEL CARMEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:DEL CARMEN
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10621 N KENDALL DR STE 113
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1549
Mailing Address - Country:US
Mailing Address - Phone:305-670-6006
Mailing Address - Fax:305-670-6007
Practice Address - Street 1:10621 N KENDALL DR STE 113
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1549
Practice Address - Country:US
Practice Address - Phone:786-397-2588
Practice Address - Fax:305-670-6007
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100361208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR16528OtherLICENCE
FLME100361OtherFLORIDA LICENSE
FL281291603Medicaid
FL281291603Medicaid