Provider Demographics
NPI:1497259196
Name:GUTIERREZ, MANUEL FERNANDO JR (MD)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:FERNANDO
Last Name:GUTIERREZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MANUEL
Other - Middle Name:
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2920 N GREEN VALLEY PKWY STE 217
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-0407
Mailing Address - Country:US
Mailing Address - Phone:702-909-8196
Mailing Address - Fax:
Practice Address - Street 1:2920 N GREEN VALLEY PKWY STE 217
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-0407
Practice Address - Country:US
Practice Address - Phone:725-724-2261
Practice Address - Fax:702-909-8213
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NV21383207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program