Provider Demographics
NPI:1699031658
Name:CHA-OS, CHITA GUTIERREZ (NURSE)
Entity Type:Individual
Prefix:MRS
First Name:CHITA
Middle Name:GUTIERREZ
Last Name:CHA-OS
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 AVENUE X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5737
Mailing Address - Country:US
Mailing Address - Phone:718-996-7090
Mailing Address - Fax:718-449-2176
Practice Address - Street 1:64 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5737
Practice Address - Country:US
Practice Address - Phone:718-996-7090
Practice Address - Fax:718-449-2176
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY420002-163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse