Healthcare Provider Details

I. General information

NPI: 1023684917
Provider Name (Legal Business Name): DANIELA ALEJANDRA GUTIERREZ MORE MS, RD, LDN, CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MCCULLOUGH DR STE 400
CHARLOTTE NC
28262-1336
US

IV. Provider business mailing address

301 MCCULLOUGH DR STE 400
CHARLOTTE NC
28262-1336
US

V. Phone/Fax

Practice location:
  • Phone: 704-819-4916
  • Fax:
Mailing address:
  • Phone: 704-925-5396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL006352
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: