MEDICARE: SARAH NICHOLE BECKER 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
1	133V00000X	Registered Dietitian	DT06318

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DT06318	OTHER	TX	TX LICENSE

General Provider Information

NPI Number	:	1639458292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH NICHOLE BECKER RD, LD

Provider Business Mailing Address
First Line	:	1045 CENTRAL PKWY N
Second Line	:	SUITE #200
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-5085
Country	:	US
Telephone Number	:	210-536-9591
Fax Number	:	904-425-2949

Provider Business Practice Location Address
First Line	:	1860 S SEGUIN AVE
Second Line	:	BLDG E
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-3914
Country	:	US
Telephone Number	:	830-626-7770
Fax Number	:	855-278-4535

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

Provider Enumeration Date	:	08/12/2011
Last Update Date	:	11/18/2016

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