MEDICARE: RUTH A O'CONNOR 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	133NN1002X	Nutrition Education Nutritionist	003044	NY

General Provider Information

NPI Number	:	1669332268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH A O'CONNOR LD

Provider Business Mailing Address
First Line	:	155 CALETA BCH
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-3833
Country	:	US
Telephone Number	:	347-424-5712
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 CALETA BCH
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-3833
Country	:	US
Telephone Number	:	347-424-5712
Fax Number	:

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

Provider Enumeration Date	:	11/15/2025
Last Update Date	:	11/15/2025

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