Individual
VICKY GUTIERREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
890 W FARIS RD STE 310, GREENVILLE, SC 29605-4281
(864) 455-8300
(864) 455-8310
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2483
SC
363AS0400X
Surgical Physician Assistant
2483
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2542PA
—
SC
01
—
SC7826
MEDICARE
SC
Enumeration date
11/23/2015
Last updated
05/26/2022
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