Provider Demographics
NPI:1619131034
Name:GUTIERREZ RAMAL, MITSI (MD)
Entity type:Individual
Prefix:
First Name:MITSI
Middle Name:
Last Name:GUTIERREZ RAMAL
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 1:6424 BERMUDA DUNES DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8801
Mailing Address - Country:US
Mailing Address - Phone:484-860-0407
Mailing Address - Fax:
Practice Address - Street 1:2601 FOREST LN
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6508
Practice Address - Country:US
Practice Address - Phone:484-860-0407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT192761207Q00000X
TXR1038207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine