Provider Demographics
NPI:1437740859
Name:MACIAS, CHELSEA KAYE (RD)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:KAYE
Last Name:MACIAS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BOSQUE BLVD UNIT 208
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76707-3837
Mailing Address - Country:US
Mailing Address - Phone:210-316-9351
Mailing Address - Fax:
Practice Address - Street 1:400 BOSQUE BLVD UNIT 208
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76707-3837
Practice Address - Country:US
Practice Address - Phone:210-316-9351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86108645133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered