Provider Demographics
NPI:1992480123
Name:GUTIERREZ, ERNESTO JAVIER I
Entity type:Individual
Prefix:
First Name:ERNESTO
Middle Name:JAVIER
Last Name:GUTIERREZ
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 S ZAPATA HWY
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-6563
Mailing Address - Country:US
Mailing Address - Phone:956-795-0700
Mailing Address - Fax:
Practice Address - Street 1:2314 S ZAPATA HWY
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046-6563
Practice Address - Country:US
Practice Address - Phone:956-795-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX289495183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician