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NPI Code Detail

MEDICARE: LAURA MELISSA SEPULVEDA-STOLL RD

MEDICARE: LAURA MELISSA SEPULVEDA-STOLL RD
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 DietitianDT83113TX

General Provider Information

NPI Number : 1275194698
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA MELISSA SEPULVEDA-STOLL RD
Provider Business Mailing Address
First Line : 12617 DRINGENBERG DR
Second Line :
City : AUSTIN
State : TX
Zip : 78729-7784
Country : US
Telephone Number : 210-216-2994
Fax Number :
Provider Business Practice Location Address
First Line : 6835 AUSTIN CENTER BLVD
Second Line :
City : AUSTIN
State : TX
Zip : 78731-3189
Country : US
Telephone Number : 512-346-6611
Fax Number : 512-406-7315
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2019
Last Update Date : 06/26/2019

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Directions to “ LAURA MELISSA SEPULVEDA-STOLL RD” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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