Provider Demographics
NPI:1891933941
Name:AIREEN L. GUTIERREZ, M.D., INC.
Entity Type:Organization
Organization Name:AIREEN L. GUTIERREZ, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFIER
Authorized Official - Prefix:DR
Authorized Official - First Name:AIREEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-461-3717
Mailing Address - Street 1:7877 PARKWAY DR
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-2000
Mailing Address - Country:US
Mailing Address - Phone:619-461-3717
Mailing Address - Fax:619-461-5941
Practice Address - Street 1:7877 PARKWAY DR
Practice Address - Street 2:SUITE 1B
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2000
Practice Address - Country:US
Practice Address - Phone:619-461-3717
Practice Address - Fax:619-461-5941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAWA77031A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH49092Medicare UPIN
CAWA77031AMedicare PIN