Healthcare Provider Details

I. General information

NPI: 1568062602
Provider Name (Legal Business Name): ALEXANDRIA FAUBION REGISTERED DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 10/28/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 40TH ST
LUBBOCK TX
79404-2746
US

IV. Provider business mailing address

301 40TH ST
LUBBOCK TX
79404-2746
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-9355
  • Fax: 806-743-9363
Mailing address:
  • Phone: 806-743-9355
  • Fax: 806-743-9363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT84767
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: