Provider Demographics
NPI:1265151286
Name:GUTIERREZ-HOSKINS, ROSA ISELA (RDH)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:ISELA
Last Name:GUTIERREZ-HOSKINS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8070 JONES CT
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME AFB
Mailing Address - State:ID
Mailing Address - Zip Code:83648-1096
Mailing Address - Country:US
Mailing Address - Phone:956-236-9357
Mailing Address - Fax:
Practice Address - Street 1:2280 AMERICAN LEGION BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-3142
Practice Address - Country:US
Practice Address - Phone:208-696-7189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDDH-4320124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist