Provider Demographics
NPI:1174556948
Name:GUTIERREZ, JOANNA MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:MICHELLE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27319 HITCHING POST CT
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-2250
Mailing Address - Country:US
Mailing Address - Phone:361-244-2629
Mailing Address - Fax:361-244-2629
Practice Address - Street 1:3326 RIDGEPOINT CT
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-5931
Practice Address - Country:US
Practice Address - Phone:281-489-6032
Practice Address - Fax:281-489-6032
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9893208100000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI39619Medicare UPIN