Provider Demographics
NPI:1568873909
Name:GUTIERREZ ALVAREZ, ANA VICTORIA (MD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:VICTORIA
Last Name:GUTIERREZ ALVAREZ
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 1:462 FIRST AVENUE
Mailing Address - Street 2:HOSPITAL BUILDING 8TH FLOOR (8W52)
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-562-6904
Mailing Address - Fax:212-562-3273
Practice Address - Street 1:706 TURLE CREEK
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1833
Practice Address - Country:US
Practice Address - Phone:903-595-3942
Practice Address - Fax:903-593-2594
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ12801208000000X
TXS8184208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP02587280OtherMEDICARE RAILROAD