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NPI Code Detail

MEDICARE: MRS. PRISCILLA BALDERRAMA MS, RD, LD

MEDICARE:  MRS. PRISCILLA  BALDERRAMA  MS, RD, LD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianDT81597TX

General Provider Information

NPI Number : 1023315652
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PRISCILLA BALDERRAMA MS, RD, LD
Provider Business Mailing Address
First Line : 3333 N MESA ST
Second Line :
City : EL PASO
State : TX
Zip : 79902-2031
Country : US
Telephone Number : 915-494-2486
Fax Number :
Provider Business Practice Location Address
First Line : 3333 N MESA ST
Second Line :
City : EL PASO
State : TX
Zip : 79902-2031
Country : US
Telephone Number : 915-494-2486
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2011
Last Update Date : 02/16/2011

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Directions to “ MRS. PRISCILLA BALDERRAMA MS, RD, LD” Practice Location

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