Provider Demographics
NPI:1457198772
Name:GUTIERREZ, ANGIE ROSE
Entity type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:ROSE
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 1:11635 CARSON FIELD LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2845
Mailing Address - Country:US
Mailing Address - Phone:832-903-6888
Mailing Address - Fax:
Practice Address - Street 1:11635 CARSON FIELD LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-2845
Practice Address - Country:US
Practice Address - Phone:832-903-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator