Provider Demographics
NPI:1376782581
Name:RASCON, ADRIANA (RD, LD, CHES)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:RASCON
Suffix:
Gender:F
Credentials:RD, LD, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32845
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0606
Mailing Address - Country:US
Mailing Address - Phone:915-276-3715
Mailing Address - Fax:800-591-4734
Practice Address - Street 1:6006 N MESA ST STE 509
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4630
Practice Address - Country:US
Practice Address - Phone:915-276-3715
Practice Address - Fax:800-591-4734
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06482133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285887001Medicaid