Healthcare Provider Details

I. General information

NPI: 1447856570
Provider Name (Legal Business Name): VALERIA SOFIA ROQUEBERT BS, RDN
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: 11/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1914 EVERGREEN BAY LN
KATY TX
77494-7742
US

IV. Provider business mailing address

1914 EVERGREEN BAY LN
KATY TX
77494-7742
US

V. Phone/Fax

Practice location:
  • Phone: 713-560-3601
  • Fax:
Mailing address:
  • Phone: 713-560-3601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: