Provider Demographics
NPI:1295224079
Name:MANENT GUTIERREZ, ANIET (MD)
Entity type:Individual
Prefix:
First Name:ANIET
Middle Name:
Last Name:MANENT GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10794 N KENDALL DR APT B2
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1418
Mailing Address - Country:US
Mailing Address - Phone:786-803-5363
Mailing Address - Fax:
Practice Address - Street 1:14875 NW 77TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2568
Practice Address - Country:US
Practice Address - Phone:305-351-7020
Practice Address - Fax:305-827-8563
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FLTRN374162081H0002X
FLACN1523208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023316200Medicaid