Provider Demographics
NPI:1720838303
Name:WOOD-GUTIERREZ, JOHANNA CELESTE (RDN)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:CELESTE
Last Name:WOOD-GUTIERREZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:CELESTE
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:3799 FM 437
Mailing Address - Street 2:
Mailing Address - City:BUCKHOLTS
Mailing Address - State:TX
Mailing Address - Zip Code:76518-2200
Mailing Address - Country:US
Mailing Address - Phone:979-257-3924
Mailing Address - Fax:
Practice Address - Street 1:3799 FM 437
Practice Address - Street 2:
Practice Address - City:BUCKHOLTS
Practice Address - State:TX
Practice Address - Zip Code:76518-2200
Practice Address - Country:US
Practice Address - Phone:979-257-3924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT88059133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered