Provider Demographics
NPI:1427235092
Name:GUTIERREZ, MADELEINE
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 CALLE SAN JULIAN
Mailing Address - Street 2:SAGRADO CORAZON
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4243
Mailing Address - Country:US
Mailing Address - Phone:787-635-1476
Mailing Address - Fax:
Practice Address - Street 1:150 CALLE FONT MARTELO
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3346
Practice Address - Country:US
Practice Address - Phone:787-861-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-26
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16953208D00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice