Provider Demographics
NPI:1912191677
Name:GUTIERREZ, ELMA ROSARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ELMA
Middle Name:ROSARIO
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELMA
Other - Middle Name:ROSARIO
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4351 E. LOHMAN AVE.
Mailing Address - Street 2:SUITE 401
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011
Mailing Address - Country:US
Mailing Address - Phone:575-522-4767
Mailing Address - Fax:575-522-3607
Practice Address - Street 1:4351 E. LOHMAN AVE.
Practice Address - Street 2:SUITE 401
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:575-522-4767
Practice Address - Fax:575-522-3607
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2008-0075207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM31284850Medicaid
NMNM301158Medicare PIN