Provider Demographics
NPI:1598722753
Name:GUTIERREZ-HEVIA, CARLOS M (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:M
Last Name:GUTIERREZ-HEVIA
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 1:7935 AIRPORT PULLING RD
Mailing Address - Street 2:STE 4 PMB 308
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-2324
Mailing Address - Country:US
Mailing Address - Phone:239-325-9694
Mailing Address - Fax:818-587-2493
Practice Address - Street 1:6545 DOMINICA DR UNIT 202
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-8187
Practice Address - Country:US
Practice Address - Phone:239-919-4889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24653174400000X
FLME108020207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051555558Medicaid
AL051555558Medicaid
AL051555558Medicare ID - Type Unspecified