Provider Demographics
NPI:1881743797
Name:GUTIERREZ, MARIA CIELO FAJARDO (CRNA)
Entity type:Individual
Prefix:MISS
First Name:MARIA CIELO
Middle Name:FAJARDO
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:2540 SHORE BLVD APT 2-0
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3941
Mailing Address - Country:US
Mailing Address - Phone:718-956-0108
Mailing Address - Fax:
Practice Address - Street 1:374 STOCKHOLM ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4006
Practice Address - Country:US
Practice Address - Phone:718-963-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY429612-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered