Provider Demographics
NPI:1447568639
Name:GUTIERREZ, LUIS ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ANTONIO
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 CAMPINDIAN HEAD RD.
Mailing Address - Street 2:
Mailing Address - City:LAND O' LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34634-0000
Mailing Address - Country:US
Mailing Address - Phone:813-948-9166
Mailing Address - Fax:
Practice Address - Street 1:2101 CAMPINDIAN HEAD RD.
Practice Address - Street 2:
Practice Address - City:LAND O' LAKES
Practice Address - State:FL
Practice Address - Zip Code:34634-0000
Practice Address - Country:US
Practice Address - Phone:813-948-9166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL151122086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery