Renegade Rd LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

RENEGADE RD LLC

Practice address

909 Balsora CV
Georgetown, TX 78628-2637

Phone

(936) 349-6546

NPI assigned

Aug 2, 2024

Last updated

Aug 2, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Santiago Capetillo Gutierrez, MS, RD, LDNPI 1104501535

Title

Registered Dietitian

Phone

(936) 349-6546

Specialties & licenses 1

Addresses

Other names 1

• The Renegade RD Other name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Santiago Capetillo Gutierrez, RD, LD

  • Registered Dietitian
  • College Station, TX
  • NPI 1104501535

  Dietitian, Registered

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722556800000",
    "number": "1467282673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17350 STATE HIGHWAY 249 STE 220",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770641132",
            "telephone_number": "936-349-6546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 BALSORA CV",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786282637",
            "telephone_number": "936-349-6546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEGADE RD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-02",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-01",
        "status": "A",
        "authorized_official_last_name": "CAPETILLO GUTIERREZ",
        "authorized_official_first_name": "SANTIAGO",
        "authorized_official_title_or_position": "REGISTERED DIETITIAN",
        "authorized_official_telephone_number": "936-349-6546",
        "authorized_official_credential": "MS, RD, LD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Renegade RD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Registered Dietitian in Georgetown, TX
• Providers in Georgetown, TX by specialty
• Registered Dietitian in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.