Provider Demographics
NPI:1942262951
Name:GUTIERREZ, JULIE A (RD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:JEFFREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2121 DIVISION RD
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-7266
Mailing Address - Country:US
Mailing Address - Phone:337-625-6765
Mailing Address - Fax:
Practice Address - Street 1:524 S RYAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5725
Practice Address - Country:US
Practice Address - Phone:337-431-7968
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1873133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H634CR91Medicare ID - Type Unspecified