Provider Demographics
NPI:1538829320
Name:GUTIERREZ GALLEGOS, KATHIA MICHEL
Entity type:Individual
Prefix:
First Name:KATHIA
Middle Name:MICHEL
Last Name:GUTIERREZ GALLEGOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12240 BELLA TERRA CENTER WAY APT 2301
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-1652
Mailing Address - Country:US
Mailing Address - Phone:210-414-7062
Mailing Address - Fax:
Practice Address - Street 1:7015 ALMEDA RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2101
Practice Address - Country:US
Practice Address - Phone:713-496-1077
Practice Address - Fax:844-682-5968
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15095363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant