Individual
GUSTAVO GUTIERREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPNP
Contact information
Practice address
800 S COUNTY LINE DR, CHAPARRAL, NM 88081
(575) 824-0820
(575) 824-1021
Mailing address
385 CALLE DE ALEGRA, BLDG. A, LAS CRUCES, NM 88005-3423
(575) 526-1105
(575) 524-4266
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP129867
TX
363LP0200X
Pediatric Nurse Practitioner
AP129867
TX
363LP0200X
Pediatric Nurse Practitioner
CNP-02890
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
48681253
—
NM
01
—
507110YRND
MEDICARE
NM
Enumeration date
01/14/2016
Last updated
12/07/2023
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