MEDICARE: AUSTIN DIABETES SERVICES

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
2	2083T0002X	Medical Toxicology (Preventive Medicine) Physician

General Provider Information

NPI Number	:	1770434086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSTIN DIABETES SERVICES

Provider Business Mailing Address
First Line	:	2612 PERSEVERANCE DR APT 2212
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-2725
Country	:	US
Telephone Number	:	737-757-4062
Fax Number	:	737-757-4062

Provider Business Practice Location Address
First Line	:	1508 DESSAU RIDGE LN STE 704
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78754-2122
Country	:	US
Telephone Number	:	737-757-4062
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	VELINDA H RIVERA
Credential	:	CHES, DCES
Telephone Number	:	737-757-4062

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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Directions to “AUSTIN DIABETES SERVICES ” Practice Location

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