Basic Information
| Provider Information | |||||||||
| NPI: | 1265096440 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUTIERREZ | ||||||||
| FirstName: | SOFIA | ||||||||
| MiddleName: | CRISTINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4100 N CIRCLE DR | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330216727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543287396 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5796 S UNIVERSITY DR STE 102 | ||||||||
| Address2: | |||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333286119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542482742 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2019 | ||||||||
| LastUpdateDate: | 02/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DN24510 | FL | Y | Dental Providers | Dentist | General Practice |
No ID Information.