Healthcare Provider Details

I. General information

NPI: 1043347347
Provider Name (Legal Business Name): JEANNE H LOOP REGISTERES DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N SAN SABA STE. 103
SAN ANTONIO TX
78207-3154
US

IV. Provider business mailing address

3750 COMMERCIAL AVE
SAN ANTONIO TX
78221-3117
US

V. Phone/Fax

Practice location:
  • Phone: 210-738-8222
  • Fax: 210-738-8644
Mailing address:
  • Phone: 210-334-3700
  • Fax: 210-922-0162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT02956
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: