Provider Demographics
NPI:1902509961
Name:GUTIERREZ, KATHERINE LUCIA (DPM)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:LUCIA
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:LUCIA
Other - Last Name:SPRUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2601 HOLME AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2096
Mailing Address - Country:US
Mailing Address - Phone:215-335-6055
Mailing Address - Fax:
Practice Address - Street 1:2601 HOLME AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2096
Practice Address - Country:US
Practice Address - Phone:215-335-6055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program