MEDICARE: LORIE ANN CASANOVA-GUIZAR

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
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1033362140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORIE ANN CASANOVA-GUIZAR

Provider Business Mailing Address
First Line	:	6315 S ZARZAMORA ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78211-3218
Country	:	US
Telephone Number	:	210-924-9254
Fax Number	:	210-921-9326

Provider Business Practice Location Address
First Line	:	2300 W COMMERCE ST
Second Line	:	SUITE 300
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-3839
Country	:	US
Telephone Number	:	210-922-0103
Fax Number	:	210-922-0162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2008
Last Update Date	:	11/03/2008

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