1346275229 NPI number — JOSE A GUTIERREZ MD PA

Table of content: (NPI 1346275229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346275229 NPI number — JOSE A GUTIERREZ MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSE A GUTIERREZ MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PSYCHIATRIC CENTER OF HOUSTON
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346275229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7500 BEECHNUT
Provider Second Line Business Mailing Address:
SUITE 214
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-772-6519
Provider Business Mailing Address Fax Number:
713-271-9943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7500 BEECHNUT
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-772-6519
Provider Business Practice Location Address Fax Number:
713-271-9943
Provider Enumeration Date:
07/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GUTIERREZ
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
713-772-6519

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  E5097 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: JP42 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10015619 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".