MEDICARE: LAURA PAMELA ACOSTA 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	DT89773	TX

General Provider Information

NPI Number	:	1669231718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA PAMELA ACOSTA RD,LD

Provider Business Mailing Address
First Line	:	2601 E YANDELL DR STE 104
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79903-3743
Country	:	US
Telephone Number	:	152-626-1929
Fax Number	:	833-526-6362

Provider Business Practice Location Address
First Line	:	2601 E YANDELL DR STE 104
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79903-3743
Country	:	US
Telephone Number	:	915-626-1929
Fax Number	:	833-526-6362

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

Provider Enumeration Date	:	03/18/2024
Last Update Date	:	03/18/2024

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