Provider Demographics
NPI:1538923479
Name:GUTIERREZ VENEGAS, GERARDO
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:GUTIERREZ VENEGAS
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:PO BOX 11356
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98909-2356
Mailing Address - Country:US
Mailing Address - Phone:509-460-3824
Mailing Address - Fax:
Practice Address - Street 1:509 CHELAN AVE
Practice Address - Street 2:
Practice Address - City:MOXEE
Practice Address - State:WA
Practice Address - Zip Code:98936-9382
Practice Address - Country:US
Practice Address - Phone:509-460-3824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC13814171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty