Provider Demographics
NPI:1487052981
Name:GUTIERREZ, LISA IVETH (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:IVETH
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4815 ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2705
Mailing Address - Country:US
Mailing Address - Phone:915-545-8823
Mailing Address - Fax:915-545-9799
Practice Address - Street 1:4815 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2705
Practice Address - Country:US
Practice Address - Phone:915-545-8823
Practice Address - Fax:915-545-9799
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2019-04-30
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Provider Licenses
StateLicense IDTaxonomies
TXBP100517142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology