MEDICARE: MRS. RENNY SAMUEL-WORSHAM M.S.,R.D.,L.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1005X	Renal Nutrition Registered Dietitian	DT01379	TX

General Provider Information

NPI Number	:	1104000298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RENNY SAMUEL-WORSHAM M.S.,R.D.,L.D.

Provider Business Mailing Address
First Line	:	25 S INWOOD HEIGHTS DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78248-1684
Country	:	US
Telephone Number	:	210-408-7223
Fax Number	:

Provider Business Practice Location Address
First Line	:	4204 GARDENDALE ST
Second Line	:	STE 106
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3138
Country	:	US
Telephone Number	:	210-325-0147
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/25/2007
Last Update Date	:	06/24/2020

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