Provider Demographics
NPI:1710769476
Name:GUTIERREZ HIDALGO, ERNESTO (RPHT)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:
Last Name:GUTIERREZ HIDALGO
Suffix:
Gender:M
Credentials:RPHT
Other - Prefix:
Other - First Name:ERNESTO
Other - Middle Name:
Other - Last Name:GUTIERREZ HIDALGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPHT
Mailing Address - Street 1:1400 NW 10TH AVE APT 1407
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1033
Mailing Address - Country:US
Mailing Address - Phone:954-348-5638
Mailing Address - Fax:305-355-2288
Practice Address - Street 1:1400 NW 10TH AVE APT 1407
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1033
Practice Address - Country:US
Practice Address - Phone:954-348-5638
Practice Address - Fax:305-355-2288
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT116679183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician