Provider Demographics
NPI:1669512638
Name:GUTIERRES-CHECK, CYNTHIA (OTR-L)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:GUTIERRES-CHECK
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11956 E RHEA RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85232-9461
Mailing Address - Country:US
Mailing Address - Phone:602-909-2406
Mailing Address - Fax:520-723-0348
Practice Address - Street 1:1362 N CASA GRANDE AVE
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-2648
Practice Address - Country:US
Practice Address - Phone:520-316-3303
Practice Address - Fax:520-316-3352
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3076174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3076OtherOT LICENSE NUMBER
AZ776023Medicaid