Healthcare Provider Details

I. General information

NPI: 1386410579
Provider Name (Legal Business Name): ANA MARIA HERNANDEZ ROSA RDN,LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9939 HIGHWAY 151
SAN ANTONIO TX
78251-1900
US

IV. Provider business mailing address

8415 FREDERICKSBURG RD APT 703
SAN ANTONIO TX
78229-3304
US

V. Phone/Fax

Practice location:
  • Phone: 210-706-7800
  • Fax:
Mailing address:
  • Phone: 787-372-5604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1101X
TaxonomyGerontological Nutrition Registered Dietitian
License Number1054161
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: