Healthcare Provider Details

I. General information

NPI: 1982303749
Provider Name (Legal Business Name): CHARIS N. GONZALEZ FUENTES RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VARMED HEALTH CENTER BUILDING B. CALLE MANUEL F. ROSSY ESQUINA ISABEL II
BAYAMON PR
00960
US

IV. Provider business mailing address

1914 CALLE 46 URB. FAIRVIEW
SAN JUAN PR
00926-7641
US

V. Phone/Fax

Practice location:
  • Phone: 787-988-2027
  • Fax:
Mailing address:
  • Phone: 787-405-8179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2223
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: