Provider Demographics
NPI:1730260225
Name:GUTIERREZ, CARMEN ROSA
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:ROSA
Last Name:GUTIERREZ
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 1:0-15 GUANABANA ST.
Mailing Address - Street 2:JARDINES DE CATANO
Mailing Address - City:CATANO
Mailing Address - State:PR
Mailing Address - Zip Code:00962-6043
Mailing Address - Country:US
Mailing Address - Phone:787-788-3691
Mailing Address - Fax:
Practice Address - Street 1:COND. GARDEN CENTER # 1 2
Practice Address - Street 2:UNIVERSITY GARDENS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-4853
Practice Address - Country:US
Practice Address - Phone:787-763-1074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist