Healthcare Provider Details

I. General information

NPI: 1871198978
Provider Name (Legal Business Name): MARIE C MOPSIK RDN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12721 CAPELLA TRL
AUSTIN TX
78732-2396
US

IV. Provider business mailing address

12721 CAPELLA TRL
AUSTIN TX
78732-2396
US

V. Phone/Fax

Practice location:
  • Phone: 512-736-7156
  • Fax:
Mailing address:
  • Phone: 512-736-7156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number17626
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: