Provider Demographics
NPI:1801697362
Name:GUTIERREZ DOS SANTOS, BRUNA (PHD, RDN)
Entity type:Individual
Prefix:
First Name:BRUNA
Middle Name:
Last Name:GUTIERREZ DOS SANTOS
Suffix:
Gender:
Credentials:PHD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 CAROWILL DR APT 206
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-3377
Mailing Address - Country:US
Mailing Address - Phone:336-662-3274
Mailing Address - Fax:
Practice Address - Street 1:503 CAROWILL DR APT 206
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-3377
Practice Address - Country:US
Practice Address - Phone:336-662-3274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86175773133VN1501X
NCL008595133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics