Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0208X | Pediatric Infectious Diseases | 0101249815 | VA |
Y | 2080P0208X | Pediatric Infectious Diseases | 56630 | AZ |
N | 2080P0208X | Pediatric Infectious Diseases | ME123953 | FL |
NPI | 1649443680 |
---|---|
Provider Name | Dr. Mavel Gutierrez-Jaramillo |
First Address | Tucson, AZ 85751-1235 |
Second Address | Tucson, AZ 85712-2155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2008 |
Last Update Date | 11/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015228600 | (05) | FL |
1502N3 | BLUE CROSS BLUE SHIELD (01) | FL |
420458 | (05) | AZ |
C06778 | GROUP PTAN (01) | VA |
C09463 | GROUP PTAN (01) | VA |