Provider Demographics
NPI:1528423688
Name:GUTIERREZ, IVON
Entity type:Individual
Prefix:
First Name:IVON
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:910 E REDD RD
Mailing Address - Street 2:# 306
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7269
Mailing Address - Country:US
Mailing Address - Phone:915-255-9281
Mailing Address - Fax:
Practice Address - Street 1:910 E REDD RD
Practice Address - Street 2:306
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7269
Practice Address - Country:US
Practice Address - Phone:915-407-4884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX522392227Medicaid
TX518856030Medicaid
TX522392226Medicaid