Provider Demographics
NPI:1164260493
Name:GUTIERREZ ROQUE, AILYN
Entity type:Individual
Prefix:
First Name:AILYN
Middle Name:
Last Name:GUTIERREZ ROQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21340 SW 112TH AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-2927
Mailing Address - Country:US
Mailing Address - Phone:786-784-8520
Mailing Address - Fax:
Practice Address - Street 1:21340 SW 112TH AVE APT 301
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-2927
Practice Address - Country:US
Practice Address - Phone:786-784-8520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician