Healthcare Provider Details

I. General information

NPI: 1669332268
Provider Name (Legal Business Name): RUTH A O'CONNOR LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2025
Last Update Date: 11/15/2025
Certification Date: 11/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 CALETA BCH
SAN ANTONIO TX
78232-3833
US

IV. Provider business mailing address

155 CALETA BCH
SAN ANTONIO TX
78232-3833
US

V. Phone/Fax

Practice location:
  • Phone: 347-424-5712
  • Fax:
Mailing address:
  • Phone: 347-424-5712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number003044
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: