Provider Demographics
NPI:1346489994
Name:AVENDANO, CARMEN A (PHD, RD)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:A
Last Name:AVENDANO
Suffix:
Gender:F
Credentials:PHD, RD
Other - Prefix:PROF
Other - First Name:CARMEN
Other - Middle Name:A
Other - Last Name:AVENDANO BENHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, RD
Mailing Address - Street 1:726 LEANN LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-6701
Mailing Address - Country:US
Mailing Address - Phone:512-259-1038
Mailing Address - Fax:
Practice Address - Street 1:726 LEANN LANE
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6701
Practice Address - Country:US
Practice Address - Phone:512-259-1038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06348133V00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB136923Medicare PIN
TXA$$$$$$$$$00696HMedicare PIN