Basic Information
| Provider Information | |||||||||
| NPI: | 1952396947 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAUTISTA-GUTIERREZ | ||||||||
| FirstName: | ANA MARIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GUTIERREZ | ||||||||
| OtherFirstName: | ANA | ||||||||
| OtherMiddleName: | MARIA | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7530 NW 25TH ST | ||||||||
| Address2: | STE B | ||||||||
| City: | BETHANY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730084914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054956340 | ||||||||
| FaxNumber: | 4054409951 | ||||||||
| Practice Location | |||||||||
| Address1: | 7530 NW 25TH ST | ||||||||
| Address2: | STE B | ||||||||
| City: | BETHANY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730084914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054956340 | ||||||||
| FaxNumber: | 4054409951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 10/15/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 15052 | OK | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.