Provider Demographics
NPI:1841071578
Name:GUTIERREZ, RICARDO (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8332 COMMERCE WAY APT 412
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1634
Mailing Address - Country:US
Mailing Address - Phone:786-800-8768
Mailing Address - Fax:
Practice Address - Street 1:3250 MARY ST STE 300
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-5293
Practice Address - Country:US
Practice Address - Phone:305-908-1115
Practice Address - Fax:305-675-3135
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029110363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty