1518454305 NPI number — HAYDEE MARITZA GUTIERREZ RN60813645

Table of content: SYLVIA OWENS CDCA (NPI 1518649573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518454305 NPI number — HAYDEE MARITZA GUTIERREZ RN60813645

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUTIERREZ
Provider First Name:
HAYDEE
Provider Middle Name:
MARITZA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN60813645
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:
1518454305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3901 W COURT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASCO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99301-2776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
668-904-7721
Provider Business Mailing Address Fax Number:
509-248-3644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 S 32ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-3635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-823-4200
Provider Business Practice Location Address Fax Number:
509-823-4220
Provider Enumeration Date:
04/17/2018

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: 363LF0000X , with the licence number:  AP61495359 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AP61495359 . This is a "WASHINGTON LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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