Provider Demographics
NPI:1447044177
Name:GUTIERREZ, GREISA
Entity type:Individual
Prefix:
First Name:GREISA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10450 NW 74TH ST UNIT 302
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2463
Mailing Address - Country:US
Mailing Address - Phone:305-322-4998
Mailing Address - Fax:
Practice Address - Street 1:10450 NW 74TH ST UNIT 302
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2463
Practice Address - Country:US
Practice Address - Phone:305-322-4998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-383841106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician