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General NPI Number Information
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NPI Number | 1821070863
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Entity Type | Individual
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Provider Name | AMBER GRAPEVINE MS, RD
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Gender | Female
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Dates
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Enumeration Date | 11/16/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1303 MCCULLOUGH AVE SUITE GL 70
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City | SAN ANTONIO
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State | TX
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Zip | 78212-5609
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Country | US
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Telephone | 210-226-9705
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Fax | 210-223-4555
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Provider Business Mailing Address
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Address Line | 367 E RAMSEY RD
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City | SAN ANTONIO
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State | TX
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Zip | 78216-4636
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Country | US
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Telephone | 210-349-9300
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Fax | 210-366-2558
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DT06583
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License Number State | TX
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