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General NPI Number Information
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NPI Number | 1457697260
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Entity Type | Organization
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Legal Business Name | CERTIFIED NUTRITION CONSULTANTS, PLLC
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Dates
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Enumeration Date | 12/26/2012
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Last Update Date | 04/23/2013
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Provider Practice Location Address
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Address Line | 855 W PRICE RD SUITE 3
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City | BROWNSVILLE
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State | TX
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Zip | 78520-8742
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Country | US
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Telephone | 956-546-4898
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Fax | 956-517-1015
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Provider Business Mailing Address
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Address Line | 14 RIO CT
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City | BROWNSVILLE
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State | TX
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Zip | 78526-2002
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Country | US
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Telephone | 956-546-4898
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Fax | 956-517-1015
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SANDRA G BETANCOURT
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Credential | R.D., L.D.
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Telephone | 956-546-4898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number | DT05843
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License Number State | TX
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