MEDICARE: MISS STEPHANIE MARIA AYALA RD

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	86174229	TX

General Provider Information

NPI Number	:	1235996513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS STEPHANIE MARIA AYALA RD

Provider Business Mailing Address
First Line	:	19611 PLANTATION GROVE TRL
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-4976
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14811 WEST RD APT 2108
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-3187
Country	:	US
Telephone Number	:	281-818-5390
Fax Number	:

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

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	03/04/2024

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