Healthcare Provider Details

I. General information

NPI: 1487412524
Provider Name (Legal Business Name): DULCE MONIQUE OLVERA RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 NORTH LOOP W STE 120
HOUSTON TX
77018-8014
US

IV. Provider business mailing address

2180 NORTH LOOP W STE 120
HOUSTON TX
77018-8014
US

V. Phone/Fax

Practice location:
  • Phone: 650-770-9243
  • Fax: 833-895-1988
Mailing address:
  • Phone: 650-770-9243
  • Fax: 833-895-1988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT87999
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: