Healthcare Provider Details

I. General information

NPI: 1871881888
Provider Name (Legal Business Name): BEVERLY MEYER CCN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12915 JONES MALTSBERGER RD STE 600
SAN ANTONIO TX
78247-4277
US

IV. Provider business mailing address

2918 HIDDEN ELM
SAN ANTONIO TX
78261-2016
US

V. Phone/Fax

Practice location:
  • Phone: 210-826-0034
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: