Provider Demographics
NPI:1912323593
Name:GUTIERREZ, GEORGINA (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:GEORGINA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:GEORGINA
Other - Middle Name:
Other - Last Name:ONTIVEROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6541 GRAND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7480
Mailing Address - Country:US
Mailing Address - Phone:915-861-4749
Mailing Address - Fax:
Practice Address - Street 1:1625 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5005
Practice Address - Country:US
Practice Address - Phone:915-747-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX747847363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner