Provider Demographics
NPI:1528802634
Name:ALFONSO, GABRIELA BEATRIZ (MS, RDN, LDN)
Entity type:Individual
Prefix:MRS
First Name:GABRIELA
Middle Name:BEATRIZ
Last Name:ALFONSO
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14105 PINE LODGE LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-9471
Mailing Address - Country:US
Mailing Address - Phone:305-582-7290
Mailing Address - Fax:
Practice Address - Street 1:14105 PINE LODGE LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-9471
Practice Address - Country:US
Practice Address - Phone:305-582-7290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND8903133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered