Provider Demographics
NPI:1659841393
Name:GUTIERREZ ACEVEDO, DIANA PAMELA (SA-C, LSA)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:PAMELA
Last Name:GUTIERREZ ACEVEDO
Suffix:
Gender:F
Credentials:SA-C, LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SUGAR CREEK CENTER BLVD
Mailing Address - Street 2:STE 618
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3560
Mailing Address - Country:US
Mailing Address - Phone:832-655-4141
Mailing Address - Fax:713-457-5188
Practice Address - Street 1:1 SUGAR CREEK BLVD
Practice Address - Street 2:STE 618
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478
Practice Address - Country:US
Practice Address - Phone:832-655-4141
Practice Address - Fax:713-457-5188
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00781363AS0400X
246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8UC174OtherUS MSO
TX8UC287OtherXCITE SURGICAL
TX8UC171OtherUNIVERSAL SURGICAL PARTNERS
TX8TP631OtherUNIVERSAL SURGICAL ASSISTANTS
TX8UC173OtherBLUE STAR SURGICAL