Individual
DR. MARIO GUTIERREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5212 BROADWAY ST, SAN ANTONIO, TX 78209-5712
(210) 829-8083
(210) 822-4011
Mailing address
5212 BROADWAY ST, SAN ANTONIO, TX 78209-5712
(210) 829-8083
(210) 822-4011
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3345TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135221306
—
TX
Enumeration date
09/16/2006
Last updated
07/08/2007
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