Provider Demographics
NPI:1932084431
Name:ALCOBA GUTIERREZ, MARIA EMILIA (LSA, CSA)
Entity type:Individual
Prefix:
First Name:MARIA EMILIA
Middle Name:
Last Name:ALCOBA GUTIERREZ
Suffix:
Gender:F
Credentials:LSA, CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 MONUMENT CORNER DR APT 908
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-8661
Mailing Address - Country:US
Mailing Address - Phone:786-495-3331
Mailing Address - Fax:
Practice Address - Street 1:4125 MONUMENT CORNER DR APT 908
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-8661
Practice Address - Country:US
Practice Address - Phone:786-495-3331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0136000952246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant