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NPI Code Detail

MEDICARE: TAILY CARMEN LOPEZ RD

MEDICARE: TAILY CARMEN LOPEZ 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 Dietitian

General Provider Information

NPI Number : 1780519371
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAILY CARMEN LOPEZ RD
Provider Business Mailing Address
First Line : 641 COMMERCIAL AVE APT B
Second Line :
City : RIDGECREST
State : CA
Zip : 93555-4254
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3724 JEFFERSON ST STE 104
Second Line :
City : AUSTIN
State : TX
Zip : 78731-6204
Country : US
Telephone Number : 512-693-7045
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2026
Last Update Date : 06/15/2026

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Directions to “ TAILY CARMEN LOPEZ RD” Practice Location

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