Provider Demographics
NPI:1689701591
Name:GUTIERREZ, CHRISTINA (OTR)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6249 W 136TH PL
Mailing Address - Street 2:
Mailing Address - City:CEDAR LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46303-8667
Mailing Address - Country:US
Mailing Address - Phone:219-776-2688
Mailing Address - Fax:
Practice Address - Street 1:5522 E 989 N
Practice Address - Street 2:
Practice Address - City:DEMOTTE
Practice Address - State:IN
Practice Address - Zip Code:46310-8016
Practice Address - Country:US
Practice Address - Phone:219-756-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003274A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist