Provider Demographics
NPI:1619131034
Name:GUTIERREZ RAMAL, MITSI (MD)
Entity Type:Individual
Prefix:
First Name:MITSI
Middle Name:
Last Name:GUTIERREZ RAMAL
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 1:2121 E GRIFFIN PKWY
Mailing Address - Street 2:SUITE 11
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3241
Mailing Address - Country:US
Mailing Address - Phone:956-424-6163
Mailing Address - Fax:956-580-7925
Practice Address - Street 1:2121 E GRIFFIN PKWY
Practice Address - Street 2:SUITE 11
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3241
Practice Address - Country:US
Practice Address - Phone:956-424-6163
Practice Address - Fax:956-580-7925
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT192761207Q00000X
TXR1038207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine