Provider Demographics
NPI:1194994681
Name:GUTENBERG, LARINA V (DO)
Entity type:Individual
Prefix:MRS
First Name:LARINA
Middle Name:V
Last Name:GUTENBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5522 LONE STAR PKWY, BLDG 2
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253
Mailing Address - Country:US
Mailing Address - Phone:210-298-4900
Mailing Address - Fax:210-298-6631
Practice Address - Street 1:5522 LONE STAR PKWY, BLDG 2
Practice Address - Street 2:STE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253
Practice Address - Country:US
Practice Address - Phone:210-298-4900
Practice Address - Fax:210-298-6631
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58. 001534207L00000X
TXN3706207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211146001Medicaid
TX8L19337Medicare PIN