Provider Demographics
NPI:1588714596
Name:NUTIS, MARIO (MD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:
Last Name:NUTIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 GATEWAY BLVD W
Mailing Address - Street 2:STE 330
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7647
Mailing Address - Country:US
Mailing Address - Phone:915-591-7277
Mailing Address - Fax:915-591-7278
Practice Address - Street 1:10201 GATEWAY BLVD W
Practice Address - Street 2:STE 330
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7647
Practice Address - Country:US
Practice Address - Phone:915-228-2491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5854207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197854603Medicaid