Healthcare Provider Details

I. General information

NPI: 1932010451
Provider Name (Legal Business Name): LOURDES ALEJANDRA CONCEPCION CALDERON RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LOURDES CONCEPCION RDN

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3724 JEFFERSON ST STE 104
AUSTIN TX
78731-6204
US

IV. Provider business mailing address

3724 JEFFERSON ST STE 104
AUSTIN TX
78731-6204
US

V. Phone/Fax

Practice location:
  • Phone: 305-942-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.024472
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: