Provider Demographics
NPI:1770631517
Name:GUTIERREZ, NITZA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NITZA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66A CALLE 2
Mailing Address - Street 2:LA CAMPINA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9639
Mailing Address - Country:US
Mailing Address - Phone:787-287-1453
Mailing Address - Fax:787-765-8986
Practice Address - Street 1:CARR # 8838 KM 5.6
Practice Address - Street 2:EDIF # 1761
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-765-9694
Practice Address - Fax:787-765-8986
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0020281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR41906OtherTRIPLE SSS
PR8475OtherFIRST MEDICAL
PR463660OtherUNITED CONCORDIA
PR9280061OtherHUMANA COMERCIAL
PR041661OtherCRUZ AZUL
PR206578OtherPREFERRED HEALTH
PR400360OtherHUMANA REFORMA