Provider Demographics
NPI:1982303749
Name:GONZALEZ FUENTES, CHARIS N (RDN)
Entity Type:Individual
Prefix:
First Name:CHARIS
Middle Name:N
Last Name:GONZALEZ FUENTES
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 CALLE 46 URB. FAIRVIEW
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7641
Mailing Address - Country:US
Mailing Address - Phone:787-405-8179
Mailing Address - Fax:
Practice Address - Street 1:VARMED HEALTH CENTER BUILDING B. CALLE MANUEL F. ROSSY
Practice Address - Street 2:ESQUINA ISABEL II
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-988-2027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2223133V00000X
PR133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered