Provider Demographics
NPI:1295126464
Name:GUTIERREZ, DANIEL ALEJANDRO (RPAC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALEJANDRO
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 VILLAGE SQUARE XING STE 290
Mailing Address - Street 2:
Mailing Address - City:PALM BCH GDNS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4552
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7765 144TH ST UNIT 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3206
Practice Address - Country:US
Practice Address - Phone:772-388-3551
Practice Address - Fax:772-388-3557
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111265363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY018002OtherREGISTRATION