Provider Demographics
NPI:1477286128
Name:BURGOS, RACHELL E (RD)
Entity Type:Individual
Prefix:
First Name:RACHELL
Middle Name:E
Last Name:BURGOS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100325
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0325
Mailing Address - Country:US
Mailing Address - Phone:352-265-0400
Mailing Address - Fax:352-265-1071
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-7401
Practice Address - Country:US
Practice Address - Phone:352-265-0400
Practice Address - Fax:352-265-1071
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNS10189133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered