Provider Demographics
NPI:1508016593
Name:GONITZKE, DARIELLA ODETTE (MS, RD)
Entity type:Individual
Prefix:
First Name:DARIELLA
Middle Name:ODETTE
Last Name:GONITZKE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:DARIELLA
Other - Middle Name:ODETTE
Other - Last Name:GAETE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD
Mailing Address - Street 1:2930 E DENNISPORT AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1460
Mailing Address - Country:US
Mailing Address - Phone:562-298-0042
Mailing Address - Fax:562-490-8582
Practice Address - Street 1:2930 E DENNISPORT AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1460
Practice Address - Country:US
Practice Address - Phone:562-298-0042
Practice Address - Fax:562-490-8582
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA994041133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered