Provider Demographics
NPI:1043234461
Name:GUTIERREZ, YOLANDA A (MD)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:A
Last Name:GUTIERREZ
Suffix:
Gender:F
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:PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39568-0726
Mailing Address - Country:US
Mailing Address - Phone:228-762-9595
Mailing Address - Fax:228-762-9494
Practice Address - Street 1:4105 HOSPITAL RD
Practice Address - Street 2:STE 104
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5312
Practice Address - Country:US
Practice Address - Phone:228-762-9595
Practice Address - Fax:228-762-9494
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS129882080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114543Medicaid
MSMC0360Medicare UPIN