Provider Demographics
NPI:1972049864
Name:GUTIERREZ, PEDRO ANGEL (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:ANGEL
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Other - Middle Name:
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Mailing Address - Street 1:12187 BEACH BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-0620
Mailing Address - Country:US
Mailing Address - Phone:904-619-8687
Mailing Address - Fax:
Practice Address - Street 1:12187 BEACH BLVD STE 10
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-0620
Practice Address - Country:US
Practice Address - Phone:904-619-8687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant