Provider Demographics
NPI:1427586205
Name:GUTIERREZ, FABIOLA D
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:D
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 NW 114TH AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4169
Mailing Address - Country:US
Mailing Address - Phone:786-333-9270
Mailing Address - Fax:305-742-2190
Practice Address - Street 1:455 NW 114TH AVE APT 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4169
Practice Address - Country:US
Practice Address - Phone:786-333-9270
Practice Address - Fax:305-742-2190
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst