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NPI Code Detail

MEDICARE: MISS KAREN ANNETTE VALLEJO RD LD

MEDICARE:  MISS KAREN ANNETTE VALLEJO  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
1133V00000XRegistered DietitianDT85562TX

General Provider Information

NPI Number : 1902387814
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KAREN ANNETTE VALLEJO RD LD
Provider Business Mailing Address
First Line : 7641 CAMBRIDGE ST
Second Line :
City : HOUSTON
State : TX
Zip : 77054-2038
Country : US
Telephone Number : 956-251-2965
Fax Number :
Provider Business Practice Location Address
First Line : 1911 NE BOB BULLOCK LOOP
Second Line :
City : LAREDO
State : TX
Zip : 78045-6596
Country : US
Telephone Number : 956-712-8053
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2018
Last Update Date : 08/28/2018

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