Provider Demographics
NPI:1558110973
Name:GUTIERREZ CRESPO, PEDRO PABLO
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:PABLO
Last Name:GUTIERREZ CRESPO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 E 7TH ST APT 1D
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4434
Mailing Address - Country:US
Mailing Address - Phone:305-370-2092
Mailing Address - Fax:
Practice Address - Street 1:51 E 7TH ST APT 1D
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4434
Practice Address - Country:US
Practice Address - Phone:305-370-2092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician