MEDICARE: JEWBELE ROBINSON 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	DT91048	TX

General Provider Information

NPI Number	:	1831900919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEWBELE ROBINSON RD

Provider Business Mailing Address
First Line	:	24625 WILDERNESS OAK APT 1206
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78260-7207
Country	:	US
Telephone Number	:	309-371-6776
Fax Number	:

Provider Business Practice Location Address
First Line	:	24625 WILDERNESS OAK APT 1206
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78260-7207
Country	:	US
Telephone Number	:	309-371-6776
Fax Number	:

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

Provider Enumeration Date	:	01/16/2025
Last Update Date	:	01/16/2025

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