Provider Demographics
NPI:1205473840
Name:GONZALEZ DELATORRE, GLORIA ISABEL (RDN, CDN)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:ISABEL
Last Name:GONZALEZ DELATORRE
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 VILLAGE GRN
Mailing Address - Street 2:
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2038
Mailing Address - Country:US
Mailing Address - Phone:347-400-3951
Mailing Address - Fax:
Practice Address - Street 1:71 VILLAGE GRN
Practice Address - Street 2:
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-2038
Practice Address - Country:US
Practice Address - Phone:347-400-3951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2719461133N00000X
174H00000X
NY86277462133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No174H00000XOther Service ProvidersHealth Educator