Healthcare Provider Details

I. General information

NPI: 1285415547
Provider Name (Legal Business Name): LUCIA GUTIERREZ RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18511 HIGHLANDER MEDICS ST
FORT BLISS TX
79906-5327
US

IV. Provider business mailing address

902 GEMBLER RD
SAN ANTONIO TX
78219-2108
US

V. Phone/Fax

Practice location:
  • Phone: 915-742-7777
  • Fax:
Mailing address:
  • Phone: 707-293-6181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: