Provider Demographics
NPI:1629354709
Name:GUADALUPE, NELSON HECTOR (DHED, MS, RD, CSSD)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:HECTOR
Last Name:GUADALUPE
Suffix:
Gender:M
Credentials:DHED, MS, RD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL MEDICAL CENTER, 100 BREWSTER BLVD.
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28547-2538
Mailing Address - Country:US
Mailing Address - Phone:910-450-4056
Mailing Address - Fax:
Practice Address - Street 1:NAVAL MEDICAL CENTER, 100 BREWSTER BLVD.
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-2538
Practice Address - Country:US
Practice Address - Phone:910-450-4056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1027320133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered