Provider Demographics
NPI:1912069907
Name:GUTIERREZ MEDICAL CENTER
Entity type:Organization
Organization Name:GUTIERREZ MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:830-775-3597
Mailing Address - Street 1:612 BEDELL AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840
Mailing Address - Country:US
Mailing Address - Phone:830-775-3597
Mailing Address - Fax:830-775-1166
Practice Address - Street 1:612 BEDELL AVE
Practice Address - Street 2:SUITE D
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840
Practice Address - Country:US
Practice Address - Phone:830-775-3597
Practice Address - Fax:830-775-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
006098OtherBCBS TEXAS
006098OtherBCBS TEXAS
TX673882Medicare Oscar/Certification