Organization
MARISELA C JAQUEZ-GUTIERREZ LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARISELA C JAQUEZ-GUTIERREZ M.D. (PRESIDENT)
(305) 392-6784
Entity
Organization
Contact information
Practice address
8181 NW 36TH ST, SUITE 1906, DORAL, FL 33166-6671
(305) 392-6784
(305) 392-6784
Mailing address
8181 NW 36TH ST, SUITE 1906, DORAL, FL 33166-6671
(305) 392-6784
(305) 392-6784
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
ME 70979
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006685400
—
FL
Enumeration date
10/02/2013
Last updated
10/02/2013
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