Provider Demographics
NPI:1457691933
Name:GUTIERREZ, CESAR ALONSO (COTA)
Entity type:Individual
Prefix:MR
First Name:CESAR
Middle Name:ALONSO
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-2161
Mailing Address - Country:US
Mailing Address - Phone:561-385-9858
Mailing Address - Fax:
Practice Address - Street 1:1519 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-2161
Practice Address - Country:US
Practice Address - Phone:561-385-9858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9838224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant