Provider Demographics
NPI:1679768865
Name:GAVINO, MA HAZEL LYN GUTIERREZ (MD)
Entity Type:Individual
Prefix:DR
First Name:MA HAZEL LYN
Middle Name:GUTIERREZ
Last Name:GAVINO
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Gender:F
Credentials:MD
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Mailing Address - Street 1:7211 W DESCHUTES AVE
Mailing Address - Street 2:STE E
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7715
Mailing Address - Country:US
Mailing Address - Phone:509-586-1157
Mailing Address - Fax:509-582-4189
Practice Address - Street 1:721 S AUBURN ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5665
Practice Address - Country:US
Practice Address - Phone:509-737-1878
Practice Address - Fax:509-737-1879
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2016-03-23
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Provider Licenses
StateLicense IDTaxonomies
MI4301090727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine