Basic Information
| Provider Information | |||||||||
| NPI: | 1649443680 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUTIERREZ-JARAMILLO | ||||||||
| FirstName: | MAVEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 31235 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857511235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203242308 | ||||||||
| FaxNumber: | 5203241406 | ||||||||
| Practice Location | |||||||||
| Address1: | 2141 N BEVERLY AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857122155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139742201 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2008 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0208X | ME123953 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases | 2080P0208X | 0101249815 | VA | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2080P0208X | 56630 | AZ | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases |
ID Information
| ID | Type | State | Issuer | Description | 1502N3 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 420458 | 05 | AZ | MEDICAID | C09463 | 01 | VA | GROUP PTAN | OTHER | 015228600 | 05 | FL | MEDICAID | C06778 | 01 | VA | GROUP PTAN | OTHER |