Provider Demographics
NPI:1578834388
Name:GUTIERREZ, ANACLETO
Entity Type:Individual
Prefix:
First Name:ANACLETO
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 W PECAN ST STE 8
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2607
Mailing Address - Country:US
Mailing Address - Phone:512-251-5977
Mailing Address - Fax:512-251-6017
Practice Address - Street 1:1101 W PECAN ST STE 8
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2607
Practice Address - Country:US
Practice Address - Phone:512-251-5977
Practice Address - Fax:512-251-6017
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other