Provider Demographics
NPI:1831907484
Name:GUTIERREZ FERNANDEZ, SADY ELENA
Entity type:Individual
Prefix:
First Name:SADY
Middle Name:ELENA
Last Name:GUTIERREZ FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10839 SW 229TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-7513
Mailing Address - Country:US
Mailing Address - Phone:786-921-8727
Mailing Address - Fax:
Practice Address - Street 1:10839 SW 229TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-7513
Practice Address - Country:US
Practice Address - Phone:786-921-8727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician