MEDICARE: JENNIFER R CALDERARO MS, RD, LD

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	DT07232	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00269395	OTHER	TX	RR/MEDICARE

General Provider Information

NPI Number	:	1225090988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER R CALDERARO MS, RD, LD

Provider Business Mailing Address
First Line	:	10024 ANAHUAC TRL
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78747-2667
Country	:	US
Telephone Number	:	512-922-4431
Fax Number	:

Provider Business Practice Location Address
First Line	:	10024 ANAHUAC TRL
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78747-2667
Country	:	US
Telephone Number	:	512-922-4431
Fax Number	:

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	09/16/2013

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