Healthcare Provider Details

I. General information

NPI: 1033362140
Provider Name (Legal Business Name): LORIE ANN CASANOVA-GUIZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W COMMERCE ST SUITE 300
SAN ANTONIO TX
78207-3839
US

IV. Provider business mailing address

6315 S ZARZAMORA ST
SAN ANTONIO TX
78211-3218
US

V. Phone/Fax

Practice location:
  • Phone: 210-922-0103
  • Fax: 210-922-0162
Mailing address:
  • Phone: 210-924-9254
  • Fax: 210-921-9326

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: