1346286457 NPI number — MRS. ADRIENNE E GUTIERREZ MD

Table of content: MRS. ADRIENNE E GUTIERREZ MD (NPI 1346286457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346286457 NPI number — MRS. ADRIENNE E GUTIERREZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUTIERREZ
Provider First Name:
ADRIENNE
Provider Middle Name:
E
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1346286457
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5641
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUMA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85366-5641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-783-5857
Provider Business Mailing Address Fax Number:
928-783-4035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2244 S AVE A
Provider Second Line Business Practice Location Address:
STE E
Provider Business Practice Location Address City Name:
YUMA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85364-2924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-230-0430
Provider Business Practice Location Address Fax Number:
810-230-6733
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  036105786 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 36943 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: L95311 . This is a "MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 320726 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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