Provider Demographics
NPI:1952396947
Name:BAUTISTA-GUTIERREZ, ANA MARIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANA MARIA
Middle Name:
Last Name:BAUTISTA-GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:MARIA
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7530 NW 25TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-4914
Mailing Address - Country:US
Mailing Address - Phone:405-495-6340
Mailing Address - Fax:405-440-9951
Practice Address - Street 1:7530 NW 25TH ST
Practice Address - Street 2:STE B
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-4914
Practice Address - Country:US
Practice Address - Phone:405-495-6340
Practice Address - Fax:405-440-9951
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK150522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E88540Medicare UPIN