Provider Demographics
NPI:1164399812
Name:GUTIERREZ GONZALEZ, EDITH DANAY (RMA)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:DANAY
Last Name:GUTIERREZ GONZALEZ
Suffix:
Gender:F
Credentials:RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12208 W DAHLIA DR
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-5313
Mailing Address - Country:US
Mailing Address - Phone:602-419-0058
Mailing Address - Fax:
Practice Address - Street 1:12208 W DAHLIA DR
Practice Address - Street 2:
Practice Address - City:EL MIRAGE
Practice Address - State:AZ
Practice Address - Zip Code:85335-5313
Practice Address - Country:US
Practice Address - Phone:602-419-0058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-18
Last Update Date:2025-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy