Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 12988 | MS |
NPI | 1043234461 |
---|---|
Provider Name | Yolanda A Gutierrez |
First Address | Pascagoula, MS 39568-0726 |
Second Address | Pascagoula, MS 39581-3609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 23/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00114543 | (05) | MS |
MC0360 | (02) | MS |