Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | AP143936 | TX |
NPI | 1083259147 |
---|---|
Provider Name | Moises Gutierrez |
First Address | El Paso, TX 79911-3600 |
Second Address | El Paso, TX 79911-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2019 |
Last Update Date | 13/11/2019 |