MEDICARE: INGRID BADILLO GONZALEZ LMT

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	133NN1002X	Nutrition Education Nutritionist
2	171400000X	Health & Wellness Coach
3	225700000X	Massage Therapist	MT127296	TX

General Provider Information

NPI Number	:	1578047981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGRID BADILLO GONZALEZ LMT

Provider Business Mailing Address
First Line	:	1808 SNAKE RIVER RD STE D
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-7746
Country	:	US
Telephone Number	:	346-546-9653
Fax Number	:	832-626-3627

Provider Business Practice Location Address
First Line	:	1808 SNAKE RIVER RD STE D
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-7746
Country	:	US
Telephone Number	:	346-546-9653
Fax Number	:	832-626-3627

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

Provider Enumeration Date	:	09/20/2018
Last Update Date	:	10/27/2025

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