Provider Demographics
NPI:1376089045
Name:GUTIERREZ, ALBERTO G
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:G
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 1:1836 EAST 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIA
Mailing Address - State:FL
Mailing Address - Zip Code:33010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1836 EAST 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010
Practice Address - Country:US
Practice Address - Phone:305-887-8844
Practice Address - Fax:305-887-6344
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10062122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist