Provider Demographics
NPI:1467634162
Name:FERNANDO X CORPUS & MINERVA F. GUTIERREZ
Entity Type:Organization
Organization Name:FERNANDO X CORPUS & MINERVA F. GUTIERREZ
Other - Org Name:AMISTAD DME LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MINERVA
Authorized Official - Middle Name:FLORES
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-781-5880
Mailing Address - Street 1:216 E EXPRESSWAY 83 STE Q
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6505
Mailing Address - Country:US
Mailing Address - Phone:956-781-5880
Mailing Address - Fax:956-781-4185
Practice Address - Street 1:216 E EXPRESSWAY 83 STE Q
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6505
Practice Address - Country:US
Practice Address - Phone:956-781-5880
Practice Address - Fax:956-781-4185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0101256332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6065240001Medicare NSC