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Individual
KATHRYNNE MAE GUTIERREZ BASA
Active
Individual
KATHRYNNE MAE GUTIERREZ BASA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
270914
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02917426
—
NY
01
—
13-1740118
TAX IDENTIFICATION
NY
01
—
270914
NYS LICENSE
NY
Enumeration date
08/22/2007
Last updated
01/17/2019
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