Provider Demographics
NPI:1336586825
Name:GUTIERREZ COTTO, YEARIM DE JESUS (MD)
Entity Type:Individual
Prefix:
First Name:YEARIM
Middle Name:DE JESUS
Last Name:GUTIERREZ COTTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YEARIM
Other - Middle Name:
Other - Last Name:GUTIERREZ COTTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:415 W 49TH ST
Mailing Address - Street 2:STE 1
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3637
Mailing Address - Country:US
Mailing Address - Phone:305-364-3404
Mailing Address - Fax:305-364-3433
Practice Address - Street 1:HC 8 BOX 38845
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-9420
Practice Address - Country:US
Practice Address - Phone:939-350-5186
Practice Address - Fax:787-738-2445
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19446207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine