Basic Information
| Provider Information | |||||||||
| NPI: | 1336142074 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUTIERREZ | ||||||||
| FirstName: | HERIBERTO | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3601 S 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857230001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207921450 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3601 S 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857233533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207921450 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2005 | ||||||||
| LastUpdateDate: | 01/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207UN0901X | 24156 | AZ | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology | 207RC0000X | 24156 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 10044506 | 01 | AZ | PPO NEXT | OTHER | 2103058 | 01 | AZ | GHI | OTHER | 14716 | 01 | AZ | ARIZONA MEDICAL NETWORK | OTHER | 25-00276 | 01 | AZ | UNITED HEALTHCARE | OTHER | 5073464 | 01 | AZ | CCN | OTHER | AZ0860280 | 01 | AZ | BCBS OF ARIZONA | OTHER | 005502490 | 01 | AZ | CIGNA | OTHER | 102609 | 01 | AZ | PREFERRED HEALTH NETWORK | OTHER | 100644 | 01 | AZ | ONE HEALTH | OTHER | 5278173 | 01 | AZ | AETNA | OTHER | 060057022 | 01 | AZ | RAILROAD MEDICARE | OTHER | 346826 | 05 | AZ | MEDICAID | 1Z3635 | 01 | AZ | HEALTH NET | OTHER | 933771 | 01 | AZ | FIRST HEALTH | OTHER | XPY197813 | 01 | CA | MEDI-CAL | OTHER |