Provider Demographics
NPI:1043646953
Name:BEDNORZ, KRISTINA ISIDORA (MDS, RD, LD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ISIDORA
Last Name:BEDNORZ
Suffix:
Gender:F
Credentials:MDS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 SACRAMENTO
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374
Mailing Address - Country:US
Mailing Address - Phone:1956-454-6053
Mailing Address - Fax:
Practice Address - Street 1:3533 S ALAMEDA
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1721
Practice Address - Country:US
Practice Address - Phone:361-694-5489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1090026133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT82893OtherLICENSED DIETITIAN