MEDICARE: MISS GABRIELA 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
1	133V00000X	Registered Dietitian	DT87710	TX

General Provider Information

NPI Number	:	1326783267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS GABRIELA GUTIERREZ RD

Provider Business Mailing Address
First Line	:	3641 MATTOX ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-1307
Country	:	US
Telephone Number	:	915-532-6280
Fax Number	:	915-598-3732

Provider Business Practice Location Address
First Line	:	3641 MATTOX ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-1307
Country	:	US
Telephone Number	:	915-532-6280
Fax Number	:	915-598-3732

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2022
Last Update Date	:	05/04/2022

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