Individual
MR. WILSON GUTIERREZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1055 N RECKER RD UNIT 1047, MESA, AZ 85205-5548
(623) 302-8137
Mailing address
PO BOX 4000, POLACCA, AZ 86042-4000
(928) 737-6000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN176420
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020529
—
AZ
Enumeration date
09/02/2014
Last updated
09/02/2014
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