Provider Demographics
NPI:1265160535
Name:GUTIERREZ, OLIVIA JOSEPHINE
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:JOSEPHINE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8130 SHUMARD OAK DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-3992
Mailing Address - Country:US
Mailing Address - Phone:210-845-6799
Mailing Address - Fax:
Practice Address - Street 1:300 W OLMOS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-1958
Practice Address - Country:US
Practice Address - Phone:210-826-1705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician