Provider Demographics
NPI:1467695189
Name:MICHELLE RENEE GUTIERREZ-MENDOZA, M.D., INC., A PROF MED CORP
Entity Type:Organization
Organization Name:MICHELLE RENEE GUTIERREZ-MENDOZA, M.D., INC., A PROF MED CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GUTIERREZ-MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-727-3451
Mailing Address - Street 1:1010 UNIVERSITY AVE
Mailing Address - Street 2:#1672
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3395
Mailing Address - Country:US
Mailing Address - Phone:619-727-3451
Mailing Address - Fax:619-260-7310
Practice Address - Street 1:4020 FIFTH AVENUE
Practice Address - Street 2:MER 14
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2180
Practice Address - Country:US
Practice Address - Phone:619-686-3577
Practice Address - Fax:619-260-7310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-10
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90028282NW0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NW0100XHospitalsGeneral Acute Care HospitalWomen