Provider Demographics
NPI:1861710253
Name:DR. ANDRES I. GUTIERREZ TORO, CSP
Entity type:Organization
Organization Name:DR. ANDRES I. GUTIERREZ TORO, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:I
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-255-1818
Mailing Address - Street 1:PO BOX 706
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0706
Mailing Address - Country:US
Mailing Address - Phone:787-255-1818
Mailing Address - Fax:787-255-1818
Practice Address - Street 1:41 CALLE CARBONELL
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3464
Practice Address - Country:US
Practice Address - Phone:787-255-1818
Practice Address - Fax:787-255-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15879261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care