Provider Demographics
NPI:1932419884
Name:ROY GUTIERREZ DBA CASA BONITA HOMES
Entity Type:Organization
Organization Name:ROY GUTIERREZ DBA CASA BONITA HOMES
Other - Org Name:CASA BONITA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGELIO
Authorized Official - Middle Name:HOMAR
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-816-1015
Mailing Address - Street 1:1124 MILNER RD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-5316
Mailing Address - Country:US
Mailing Address - Phone:972-816-1015
Mailing Address - Fax:972-579-0338
Practice Address - Street 1:1124 MILNER RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-5316
Practice Address - Country:US
Practice Address - Phone:972-816-1015
Practice Address - Fax:972-579-0338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13566171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty