Provider Demographics
NPI:1033362140
Name:CASANOVA-GUIZAR, LORIE ANN
Entity Type:Individual
Prefix:
First Name:LORIE
Middle Name:ANN
Last Name:CASANOVA-GUIZAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 S ZARZAMORA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78211-3218
Mailing Address - Country:US
Mailing Address - Phone:210-924-9254
Mailing Address - Fax:210-921-9326
Practice Address - Street 1:2300 W COMMERCE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3839
Practice Address - Country:US
Practice Address - Phone:210-922-0103
Practice Address - Fax:210-922-0162
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered