Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 11006932 | FL |
NPI | 1003437831 |
---|---|
Provider Name | Marisol Gutierrez |
First Address | Miami, FL 33196-1070 |
Second Address | Miami, FL 33186-1829 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2020 |
Last Update Date | 04/05/2020 |