Provider Demographics
NPI:1588634919
Name:GUTIERREZ, ANDRES IVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:IVAN
Last Name:GUTIERREZ
Suffix:
Gender:M
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:PO BOX 596
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-0596
Mailing Address - Country:US
Mailing Address - Phone:787-899-3928
Mailing Address - Fax:787-899-3928
Practice Address - Street 1:316 RD KM 0.9 CANDELARIA
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667-0596
Practice Address - Country:US
Practice Address - Phone:787-899-3928
Practice Address - Fax:787-899-3928
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15879208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2-3398Medicare ID - Type Unspecified
PRI-46644Medicare UPIN