Provider Demographics
NPI:1114617800
Name:EUAN LOPEZ, YARELY SUIDE GUADALUPE (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:YARELY
Middle Name:SUIDE GUADALUPE
Last Name:EUAN LOPEZ
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16736 PORTERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-1289
Mailing Address - Country:US
Mailing Address - Phone:970-889-2630
Mailing Address - Fax:
Practice Address - Street 1:16736 PORTERFIELD LN
Practice Address - Street 2:
Practice Address - City:JUSTIN
Practice Address - State:TX
Practice Address - Zip Code:76247-1289
Practice Address - Country:US
Practice Address - Phone:970-889-2630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT88505133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered