Healthcare Provider Details

I. General information

NPI: 1104534304
Provider Name (Legal Business Name): ANA FLORENCIA MOYEDA CARABAZA PHD, RDN, LD, LMNT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 LONDONDERRY DR STE 310
WACO TX
76712-7922
US

IV. Provider business mailing address

379 CAVITT CT
WACO TX
76706-4815
US

V. Phone/Fax

Practice location:
  • Phone: 254-751-4097
  • Fax:
Mailing address:
  • Phone: 806-548-7994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT89982
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1640
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: