Provider Demographics
NPI:1801145669
Name:GUTIERREZ, RAFAEL A
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:A
Last Name:GUTIERREZ
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 1:937 CALLE DURBEC
Mailing Address - Street 2:URB COUNTRY CLUB
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-3377
Mailing Address - Country:US
Mailing Address - Phone:787-598-7116
Mailing Address - Fax:787-753-6443
Practice Address - Street 1:COND PARK CT
Practice Address - Street 2:EDIFICIO V PFIZER TOWER SUIT 301
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2229
Practice Address - Country:US
Practice Address - Phone:787-641-0773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program