Provider Demographics
NPI:1811529944
Name:GUTIERREZ MIRABAL, PURA ISABEL (MD)
Entity type:Individual
Prefix:
First Name:PURA
Middle Name:ISABEL
Last Name:GUTIERREZ MIRABAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WYOMING ST
Mailing Address - Street 2:BERRY GROUND 020
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2722
Mailing Address - Country:US
Mailing Address - Phone:937-208-2850
Mailing Address - Fax:937-208-2752
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:937-208-2850
Practice Address - Fax:937-208-2752
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program