Provider Demographics
NPI:1649946971
Name:GUTIERREZ FERNANDEZ, JOANGELYS (LND)
Entity type:Individual
Prefix:
First Name:JOANGELYS
Middle Name:
Last Name:GUTIERREZ FERNANDEZ
Suffix:
Gender:
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SAN CRISTOBAL CALLE CRISTOBAL CRUET
Mailing Address - Street 2:CASA #266
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736
Mailing Address - Country:US
Mailing Address - Phone:787-363-5169
Mailing Address - Fax:
Practice Address - Street 1:URB. SAN CRISTOBAL CALLE CRISTOBAL CRUET
Practice Address - Street 2:CASA #266
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-363-5169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2168133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2168Medicaid