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 1:1777 N BELLFLOWER BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4013
Mailing Address - Country:US
Mailing Address - Phone:562-298-0042
Mailing Address - Fax:
Practice Address - Street 1:1777 N BELLFLOWER BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4013
Practice Address - Country:US
Practice Address - Phone:562-298-0042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA994041133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered