Provider Demographics
NPI:1063606531
Name:GUTIERREZ, ZAIDA (RD)
Entity type:Individual
Prefix:MRS
First Name:ZAIDA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8613
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33758-8613
Mailing Address - Country:US
Mailing Address - Phone:727-446-4646
Mailing Address - Fax:
Practice Address - Street 1:1441 PINE ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-6168
Practice Address - Country:US
Practice Address - Phone:727-446-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered