Provider Demographics
NPI:1508946401
Name:GUTIERREZ, NANCY MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:MARIA
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1756 N BAYSHORE DR APT 26B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-2720
Mailing Address - Country:US
Mailing Address - Phone:786-423-6889
Mailing Address - Fax:
Practice Address - Street 1:615 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-6213
Practice Address - Country:US
Practice Address - Phone:305-535-5540
Practice Address - Fax:305-535-5543
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043282208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD64889Medicare UPIN
FL96404Medicare ID - Type Unspecified