Provider Demographics
NPI:1720221948
Name:GUTIERREZ, ROBERTO OCAMPO (IDMT)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:OCAMPO
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 78
Mailing Address - Street 2:BOX 257
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96326-0078
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MDOS
Practice Address - Street 2:UNIT 5227
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96328
Practice Address - Country:US
Practice Address - Phone:315-225-7265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians