Provider Demographics
NPI:1407170368
Name:GUTIERREZ, DAVID MIGUEL MARTIN (LSA)
Entity Type:Individual
Prefix:
First Name:DAVID MIGUEL
Middle Name:MARTIN
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:11126 CHELSEA OAK ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5478
Mailing Address - Country:US
Mailing Address - Phone:832-493-0969
Mailing Address - Fax:832-575-4762
Practice Address - Street 1:11126 CHELSEA OAK ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5478
Practice Address - Country:US
Practice Address - Phone:832-493-0969
Practice Address - Fax:832-575-4762
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXSA00447208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery