Provider Demographics
NPI:1356626782
Name:VERA, ANGELA W (RD, LD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:W
Last Name:VERA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 WATERWAY CV
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:TX
Mailing Address - Zip Code:75791-9545
Mailing Address - Country:US
Mailing Address - Phone:903-714-9858
Mailing Address - Fax:
Practice Address - Street 1:1704 WATERWAY CV
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:TX
Practice Address - Zip Code:75791-9545
Practice Address - Country:US
Practice Address - Phone:903-714-9858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06657133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered