Provider Demographics
NPI:1861909467
Name:GUTIERREZ GARCES, HECTOR LUIS
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:LUIS
Last Name:GUTIERREZ GARCES
Suffix:
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 1:955 NW 126TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2044
Mailing Address - Country:US
Mailing Address - Phone:786-351-4278
Mailing Address - Fax:
Practice Address - Street 1:12905 SW 42ND ST STE 213
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2912
Practice Address - Country:US
Practice Address - Phone:786-507-8830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9381769363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty