Provider Demographics
NPI:1962482885
Name:GUTIERREZ, LISSETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISSETTE
Middle Name:
Last Name:GUTIERREZ
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 1:12955 SW 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-6259
Mailing Address - Country:US
Mailing Address - Phone:787-360-4751
Mailing Address - Fax:787-844-6130
Practice Address - Street 1:PLAZOLETA LA CERAMICA SUITE 2 AL 6
Practice Address - Street 2:AVE SANCHEZ VILELLA ESQUINA PR-190
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:855-711-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13364207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20958Medicare ID - Type Unspecified
PRH70724Medicare UPIN