Healthcare Provider Details

I. General information

NPI: 1821907718
Provider Name (Legal Business Name): KENDAL ALEXIS GUTIERREZ RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 BELLWETHER WAY STE 223
BELLINGHAM WA
98225-2914
US

IV. Provider business mailing address

7303 W MONTGOMERY RD
PEORIA AZ
85383-5300
US

V. Phone/Fax

Practice location:
  • Phone: 360-230-8202
  • Fax:
Mailing address:
  • Phone: 623-680-8786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: