Provider Demographics
NPI:1427572577
Name:GUTIERREZ, MARIO ALBERTO (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:ALBERTO
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1350 JACKE ST. SE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124
Mailing Address - Country:US
Mailing Address - Phone:505-238-2997
Mailing Address - Fax:505-544-4631
Practice Address - Street 1:1350 JACKE ST. SE
Practice Address - Street 2:SUITE 104
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124
Practice Address - Country:US
Practice Address - Phone:505-238-2997
Practice Address - Fax:505-544-4631
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMCNP-03296363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health