=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770434086
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUSTIN DIABETES SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2026
-----------------------------------------------------
Last Update Date | 02/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1508 DESSAU RIDGE LN STE 704
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78754-2122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 737-757-4062
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2612 PERSEVERANCE DR APT 2212
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78731-2725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 737-757-4062
-----------------------------------------------------
Fax | 737-757-4062
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | VELINDA H RIVERA
-----------------------------------------------------
Credential | CHES, DCES
-----------------------------------------------------
Telephone | 737-757-4062
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133NN1002X
-----------------------------------------------------
Taxonomy Name | Nutrition Education Nutritionist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2083T0002X
-----------------------------------------------------
Taxonomy Name | Medical Toxicology (Preventive Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------