MEDICARE: DULCE MAGDALENA RAVEN RDN

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	133V00000X	Registered Dietitian	86050078	TX

General Provider Information

NPI Number	:	1184339384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DULCE MAGDALENA RAVEN RDN

Provider Business Mailing Address
First Line	:	3505 SANTA SOFIA ST
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78572-7536
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3505 SANTA SOFIA ST
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78572-7536
Country	:	US
Telephone Number	:	956-249-3941
Fax Number	:

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

Provider Enumeration Date	:	01/23/2023
Last Update Date	:	01/23/2023

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Directions to “ DULCE MAGDALENA RAVEN RDN” Practice Location

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