1093464257 NPI number — NP BENISE GUTIERREZ

Table of content: (NPI 1093464257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093464257 NPI number — NP BENISE GUTIERREZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NP BENISE GUTIERREZ
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:
Provider Other Organization Name Type Code:
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:
1093464257
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10144 ARBOR RUN DR UNIT 152
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33647-3572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-507-5083
Provider Business Mailing Address Fax Number:
888-727-0593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10144 ARBOR RUN DR UNIT 152
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33647-3572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-507-5083
Provider Business Practice Location Address Fax Number:
888-727-0593
Provider Enumeration Date:
03/23/2022

Additional Information

Authorized Official

Authorized Official Last Name:
ARTUS
Authorized Official First Name:
BENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
813-507-5083

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G362-061-89-632-0 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com