Provider Demographics
NPI:1467701516
Name:URGENT CARE CENTER - JUAN GUTIERREZ, M.D.
Entity Type:Organization
Organization Name:URGENT CARE CENTER - JUAN GUTIERREZ, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-227-6618
Mailing Address - Street 1:11880 SW 40TH ST STE 404
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3575
Mailing Address - Country:US
Mailing Address - Phone:305-227-6618
Mailing Address - Fax:305-227-6668
Practice Address - Street 1:11880 SW 40TH ST STE 404
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3575
Practice Address - Country:US
Practice Address - Phone:305-227-6618
Practice Address - Fax:305-227-6668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40749261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068939400Medicaid
FL068939400Medicaid
FL96185Medicare PIN