Provider Demographics
NPI:1295055234
Name:GUTIERREZ, PAOLA ANDREA
Entity type:Individual
Prefix:
First Name:PAOLA
Middle Name:ANDREA
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 1:521 RIVER RD FL 2
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1146
Mailing Address - Country:US
Mailing Address - Phone:201-943-3030
Mailing Address - Fax:201-943-3039
Practice Address - Street 1:521 RIVER RD FL 2
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1146
Practice Address - Country:US
Practice Address - Phone:201-943-3030
Practice Address - Fax:201-943-3039
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225700000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist