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NPI Code Detail

MEDICARE: JULIE A GUTIERREZ RD

MEDICARE: JULIE A GUTIERREZ RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian1873LA

General Provider Information

NPI Number : 1942262951
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE A GUTIERREZ RD
Provider Business Mailing Address
First Line : 2121 DIVISION RD
Second Line :
City : SULPHUR
State : LA
Zip : 70663-7266
Country : US
Telephone Number : 337-625-6765
Fax Number :
Provider Business Practice Location Address
First Line : 524 S RYAN ST
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70601-5725
Country : US
Telephone Number : 337-431-7968
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2006
Last Update Date : 07/08/2007

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Directions to “ JULIE A GUTIERREZ RD” Practice Location

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