Provider Demographics
NPI:1992148605
Name:GUTIERREZ LOPEZ, KARINA (MD)
Entity type:Individual
Prefix:MS
First Name:KARINA
Middle Name:
Last Name:GUTIERREZ LOPEZ
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 1:441 HIGHWAY 71 W
Mailing Address - Street 2:SUITE C
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-3931
Mailing Address - Country:US
Mailing Address - Phone:512-304-0313
Mailing Address - Fax:
Practice Address - Street 1:441 HIGHWAY 71 W
Practice Address - Street 2:SUITE C
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3931
Practice Address - Country:US
Practice Address - Phone:512-304-0313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10045833207Q00000X
TXQ6842207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX360243501Medicaid
TX512372YL9XMedicare PIN