Provider Demographics
NPI:1366044356
Name:GUTIERREZ, ABRAHAM ALBERTO
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:ALBERTO
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 1:8727 N 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-3925
Mailing Address - Country:US
Mailing Address - Phone:480-516-1405
Mailing Address - Fax:
Practice Address - Street 1:8687 E VIA DE VENTURA
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3347
Practice Address - Country:US
Practice Address - Phone:480-516-1405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP050050164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse