Individual
JACKSON LUIS GUTIERREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
18470 E LARK DR, QUEEN CREEK, AZ 85142-5170
(615) 282-1052
Mailing address
18470 E LARK DR, QUEEN CREEK, AZ 85142-5170
(615) 282-1052
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
279143
AZ
Other
Enumeration date
06/29/2023
Last updated
06/29/2023
About Stedi
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