Provider Demographics
NPI:1225090988
Name:CALDERARO, JENNIFER R (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:CALDERARO
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10024 ANAHUAC TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-2667
Mailing Address - Country:US
Mailing Address - Phone:512-922-4431
Mailing Address - Fax:
Practice Address - Street 1:10024 ANAHUAC TRL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78747-2667
Practice Address - Country:US
Practice Address - Phone:512-922-4431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07232133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00269395OtherRR/MEDICARE
TXQ38793Medicare UPIN
TX8D9842Medicare ID - Type Unspecified