Basic Information
| Provider Information | |||||||||
| NPI: | 1568873909 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUTIERREZ ALVAREZ | ||||||||
| FirstName: | ANA | ||||||||
| MiddleName: | VICTORIA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 462 FIRST AVENUE | ||||||||
| Address2: | HOSPITAL BUILDING 8TH FLOOR (8W52) | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125626904 | ||||||||
| FaxNumber: | 2125623273 | ||||||||
| Practice Location | |||||||||
| Address1: | 706 TURLE CREEK | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757011833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035953942 | ||||||||
| FaxNumber: | 9035932594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2014 | ||||||||
| LastUpdateDate: | 02/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 12801 | ZZ | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | S8184 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | P02587280 | 01 | TX | MEDICARE RAILROAD | OTHER |