Provider Demographics
NPI:1013227842
Name:GUTIERREZ, LETICIA (MSRDLD)
Entity Type:Individual
Prefix:MS
First Name:LETICIA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MSRDLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6023 WOOD BYU
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-1906
Mailing Address - Country:US
Mailing Address - Phone:210-558-8522
Mailing Address - Fax:
Practice Address - Street 1:200 CONCORD PLAZA DRIVE
Practice Address - Street 2:SUITE 430
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6997
Practice Address - Country:US
Practice Address - Phone:210-477-9242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80401133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered