Healthcare Provider Details

I. General information

NPI: 1356650691
Provider Name (Legal Business Name): ANNA MARIE DEAN RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14207 HIGGINS RD
SAN ANTONIO TX
78217-1252
US

IV. Provider business mailing address

14207 HIGGINS RD
SAN ANTONIO TX
78217-1252
US

V. Phone/Fax

Practice location:
  • Phone: 210-826-4492
  • Fax:
Mailing address:
  • Phone: 979-676-2540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT81693
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: