Provider Demographics
NPI:1013928985
Name:GUTIERREZ, PETE (MD/PA)
Entity Type:Individual
Prefix:
First Name:PETE
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MD/PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 NW 1ST AVE
Mailing Address - Street 2:971 NW 2ND STREET
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-4901
Mailing Address - Country:US
Mailing Address - Phone:305-572-2026
Mailing Address - Fax:305-572-2025
Practice Address - Street 1:2015 NW 1ST AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-4901
Practice Address - Country:US
Practice Address - Phone:305-572-2026
Practice Address - Fax:305-572-2025
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3622208D00000X
FLACN296261QC1500X
PRMD11514261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP05571Medicare UPIN