Provider Demographics
NPI:1053110049
Name:GUTIERREZ RIVERA, JIMENA (MD)
Entity type:Individual
Prefix:
First Name:JIMENA
Middle Name:
Last Name:GUTIERREZ RIVERA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 E CARTMILL AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-9610
Mailing Address - Country:US
Mailing Address - Phone:559-686-9097
Mailing Address - Fax:
Practice Address - Street 1:1134 E CARTMILL AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-9610
Practice Address - Country:US
Practice Address - Phone:559-686-9097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP210001208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics