Provider Demographics
NPI:1508515701
Name:GUTIERREZ HERRERA, MAYRA (PA)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:GUTIERREZ HERRERA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8114 HALL VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-1413
Mailing Address - Country:US
Mailing Address - Phone:832-889-8129
Mailing Address - Fax:
Practice Address - Street 1:8114 HALL VIEW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-1413
Practice Address - Country:US
Practice Address - Phone:832-889-8129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1240-P.A.363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical