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Provider Information for 1164447785

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Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

ANDREA M GUTIERREZ DO

Gender: FEMALE

Individual NPI: 1164447785

Calendar   Last Updated:  2016-09-02
  Certification Date: 

Details

Name Value
NPI 1164447785
Enumeration Date 2006-07-13
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 1 ROYCE CIRCLE SUITE 104 UCONN MEDICAL GROUP
STORRS, CT 06268
United States

Phone: 860-487-9200 | Fax: 860-487-9222
View Map External Link
Primary Practice Address 1 ROYCE CIRCLE SUITE 104 UCONN MEDICAL GROUP
STORRS, CT 06268
United States

Phone: 860-487-9200 | Fax: 860-487-9222
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID CT 001416701
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207Q00000X - Family Medicine CT 041670