Provider Demographics
NPI:1942452628
Name:GUTIERREZ DEL ARROYO COLON, MARISEL (MD)
Entity Type:Individual
Prefix:
First Name:MARISEL
Middle Name:
Last Name:GUTIERREZ DEL ARROYO COLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6675 WESTWOOD BLVD STE 475
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-6027
Mailing Address - Country:US
Mailing Address - Phone:407-845-0330
Mailing Address - Fax:888-972-1752
Practice Address - Street 1:2285 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2703
Practice Address - Country:US
Practice Address - Phone:407-955-4464
Practice Address - Fax:321-282-6768
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN737208D00000X
PR17350208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN737OtherMEDICAL LICENSE
FLFG1124863OtherDEA
FLFG1124863OtherDEA