Provider Demographics
NPI:1578286969
Name:GUTIERREZ, GREIVIS JOSE SR
Entity type:Individual
Prefix:
First Name:GREIVIS
Middle Name:JOSE
Last Name:GUTIERREZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 RIDGEVIEW CIR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8453
Mailing Address - Country:US
Mailing Address - Phone:407-954-2438
Mailing Address - Fax:
Practice Address - Street 1:1348 RIDGEVIEW CIR UNIT 101
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33896-8453
Practice Address - Country:US
Practice Address - Phone:407-954-2438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-234498106S00000X
FL1-25-83214103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician