Provider Demographics
NPI:1497105142
Name:GUTIEREZ, GERARDO LORENZO (RN)
Entity Type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:LORENZO
Last Name:GUTIEREZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 N. PIEDRAS
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-742-2511
Mailing Address - Fax:
Practice Address - Street 1:5005 N. PIEDRAS
Practice Address - Street 2:US ARMY DENTAL ACTIVITY
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-742-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX643158163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse