Provider Demographics
NPI:1992586317
Name:GUTIERREZ SERRANO, NOEL ALEJANDRO
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:ALEJANDRO
Last Name:GUTIERREZ SERRANO
Suffix:
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 1:4001 E 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-2913
Mailing Address - Country:US
Mailing Address - Phone:786-641-1647
Mailing Address - Fax:
Practice Address - Street 1:4001 E 10TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-2913
Practice Address - Country:US
Practice Address - Phone:786-641-1647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-294696106S00000X
AZRBT-23-294696106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician