Provider Demographics
NPI:1346839743
Name:GUTIERREZ, ARMANDO
Entity Type:Individual
Prefix:
First Name:ARMANDO
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13315 SPRUCE RUN DR APT 103
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-4295
Mailing Address - Country:US
Mailing Address - Phone:619-771-5000
Mailing Address - Fax:
Practice Address - Street 1:2123 FRANKLIN DR NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4022
Practice Address - Country:US
Practice Address - Phone:321-724-1614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1015147163WP0809X
FL9564610163WP0809X
OH468187163WP0809X
FL11013408363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult