Basic Information
Provider Information
NPI: 1568487502
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GUTIERREZ
FirstName: CHRISTINA
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3811 MORGANS CRK
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782301943
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1200 BROOKLYN AVE
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782124803
CountryCode: US
TelephoneNumber: 2102280705
FaxNumber: 2104720255
Other Information
ProviderEnumerationDate: 07/12/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XL4413TXY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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