Provider Demographics
NPI:1407324346
Name:VERDUZCO, JOSHUA JEDIDIAH (RDN, LD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JEDIDIAH
Last Name:VERDUZCO
Suffix:
Gender:M
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78416-1554
Mailing Address - Country:US
Mailing Address - Phone:361-232-2002
Mailing Address - Fax:
Practice Address - Street 1:1806 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78416-1554
Practice Address - Country:US
Practice Address - Phone:361-232-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85302133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered