Individual
BRANDON GUTIERREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
29 EDWARD ST, CENTEREACH, NY 11720-2138
(631) 524-1317
Mailing address
29 EDWARD ST, CENTEREACH, NY 11720-2138
(631) 524-1317
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
820419
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
820419
LICENSE NUMBER
—
Enumeration date
10/13/2021
Last updated
10/13/2021
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