Provider Demographics
NPI:1427649094
Name:GUTIERREZ, JOSELO (L AC)
Entity type:Individual
Prefix:
First Name:JOSELO
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 CONNECTICUT AVE NW STE 1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-1370
Mailing Address - Country:US
Mailing Address - Phone:202-421-1291
Mailing Address - Fax:
Practice Address - Street 1:1627 CONNECTICUT AVE NW STE 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-1370
Practice Address - Country:US
Practice Address - Phone:202-421-1291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAC500151171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist