Provider Demographics
NPI:1386750123
Name:GUTIERREZ, RICARDO (NP)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-2276
Mailing Address - Country:US
Mailing Address - Phone:956-787-8915
Mailing Address - Fax:956-787-2021
Practice Address - Street 1:301 S 17TH ST
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-3438
Practice Address - Country:US
Practice Address - Phone:956-464-5809
Practice Address - Fax:956-464-5816
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX685411363L00000X
TXAP114357363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner