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General NPI Number Information
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NPI Number | 1306461504
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Entity Type | Individual
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Provider Name | ELIZABETH DIANE MCKENZIE
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Gender | Female
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Dates
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Enumeration Date | 06/12/2020
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 7703 FLOYD CURL DR
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3901
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Country | US
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Telephone | 210-325-5748
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Fax |
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Provider Business Mailing Address
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Address Line | 2219 PEBBLE CREST CIR
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City | SAN ANTONIO
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State | TX
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Zip | 78231-1927
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Country | US
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Telephone | 312-371-5656
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | DT03995
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number | DT03995
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DT03995
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License Number State | TX
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