Provider Demographics
NPI:1487760443
Name:GUTIERREZ, JOSE V SR
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:V
Last Name:GUTIERREZ
Suffix:SR
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 124
Mailing Address - Street 2:
Mailing Address - City:LOIZA
Mailing Address - State:PR
Mailing Address - Zip Code:00772-0124
Mailing Address - Country:US
Mailing Address - Phone:787-256-2277
Mailing Address - Fax:787-957-2319
Practice Address - Street 1:47 CALLE SAN PATRICIO
Practice Address - Street 2:
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772-1751
Practice Address - Country:US
Practice Address - Phone:787-568-0569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0088073Medicare ID - Type UnspecifiedGENERAL MEDICINE
PRG42502Medicare UPIN