Provider Demographics
NPI:1083460760
Name:GUTIERREZ ALONSO, JOSE CARLOS
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:CARLOS
Last Name:GUTIERREZ ALONSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11990 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1602
Mailing Address - Country:US
Mailing Address - Phone:305-322-0977
Mailing Address - Fax:
Practice Address - Street 1:5040 NW 7TH ST STE 660
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3485
Practice Address - Country:US
Practice Address - Phone:305-900-2361
Practice Address - Fax:305-900-2371
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator