Individual
LISANDRO ARIEL GUTIERRZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2104 JANE ST, WACO, TX 76711-2012
(254) 424-7392
Mailing address
2104 JANE ST, WACO, TX 76711-2012
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
307541
TX
Other
Enumeration date
02/15/2018
Last updated
02/15/2018
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