MEDICARE: CHRISTINA LYNN FERRIOLA 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	DT84199	TX

General Provider Information

NPI Number	:	1972082162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA LYNN FERRIOLA LD

Provider Business Mailing Address
First Line	:	2510 S LOOP 336 W STE 215B
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-3737
Country	:	US
Telephone Number	:	936-596-0445
Fax Number	:	936-571-0337

Provider Business Practice Location Address
First Line	:	2510 S LOOP 336 W STE 215B
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-3737
Country	:	US
Telephone Number	:	936-596-0445
Fax Number	:	936-571-0337

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

Provider Enumeration Date	:	08/09/2018
Last Update Date	:	05/29/2026

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