Provider Demographics
NPI:1386220564
Name:GUTIERREZ, AMALIA N/A (CSFA)
Entity type:Individual
Prefix:
First Name:AMALIA
Middle Name:N/A
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 ITHACA CT APT 901
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-7182
Mailing Address - Country:US
Mailing Address - Phone:518-361-4912
Mailing Address - Fax:
Practice Address - Street 1:455 ITHACA CT APT 901
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-7182
Practice Address - Country:US
Practice Address - Phone:518-361-4912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant