Provider Demographics
NPI:1093860728
Name:MASSIEU, LEONOR ADRIANA (RD, LD, CNSD)
Entity Type:Individual
Prefix:MRS
First Name:LEONOR
Middle Name:ADRIANA
Last Name:MASSIEU
Suffix:
Gender:F
Credentials:RD, LD, CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11114 BURDINE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-6106
Mailing Address - Country:US
Mailing Address - Phone:713-723-1703
Mailing Address - Fax:
Practice Address - Street 1:11114 BURDINE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-6106
Practice Address - Country:US
Practice Address - Phone:713-723-1703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05713133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric