Provider Demographics
NPI:1922042985
Name:GUTIERREZ, CARLOS ABRAHAM (MD, FAAP)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ABRAHAM
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 PERSHING DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-3608
Mailing Address - Country:US
Mailing Address - Phone:915-590-5600
Mailing Address - Fax:915-590-7367
Practice Address - Street 1:2325 PERSHING DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3608
Practice Address - Country:US
Practice Address - Phone:915-590-5600
Practice Address - Fax:915-590-7367
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8501208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161340801Medicaid
TXC16409Medicare UPIN