Provider Demographics
NPI:1114436938
Name:BREAUX, JOANN (RDN, LD)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:BREAUX
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4437 CADDO LN
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-9713
Mailing Address - Country:US
Mailing Address - Phone:956-212-6032
Mailing Address - Fax:
Practice Address - Street 1:901 TRENTON RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-7705
Practice Address - Country:US
Practice Address - Phone:956-618-1889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86069510133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered