Provider Demographics
NPI:1689309254
Name:GUTIERREZ, MARIO ALBERTO
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:ALBERTO
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 839966
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78283-3966
Mailing Address - Country:US
Mailing Address - Phone:210-207-7729
Mailing Address - Fax:
Practice Address - Street 1:515 CASTROVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-3131
Practice Address - Country:US
Practice Address - Phone:210-207-7729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator