Provider Demographics
NPI:1619110707
Name:GUTIERREZ, JOAQUIN C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAQUIN
Middle Name:C
Last Name:GUTIERREZ
Suffix:JR
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 1:124 GETZ AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2114
Mailing Address - Country:US
Mailing Address - Phone:718-967-2902
Mailing Address - Fax:
Practice Address - Street 1:124 GETZ AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2114
Practice Address - Country:US
Practice Address - Phone:718-967-2902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161519207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine