Provider Demographics
NPI:1982482113
Name:GUTIERREZ, LILI (LMT)
Entity Type:Individual
Prefix:
First Name:LILI
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LILIA
Other - Middle Name:
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1361 AMBER MORGAN DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7880
Mailing Address - Country:US
Mailing Address - Phone:915-777-1553
Mailing Address - Fax:
Practice Address - Street 1:1875 SAUL KLEINFELD DR STE 108
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-3795
Practice Address - Country:US
Practice Address - Phone:915-300-7651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT136514225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist