Provider Demographics
NPI:1467234534
Name:CENTRAL TEXAS DIABETES AND NUTRITION SPECIALISTS
Entity Type:Organization
Organization Name:CENTRAL TEXAS DIABETES AND NUTRITION SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIETITIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:NUNN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LD
Authorized Official - Phone:512-413-8377
Mailing Address - Street 1:10301 BURNET RD APT 1352
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-4590
Mailing Address - Country:US
Mailing Address - Phone:512-413-8377
Mailing Address - Fax:
Practice Address - Street 1:10301 BURNET RD APT 1352
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-4590
Practice Address - Country:US
Practice Address - Phone:512-413-8377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-13
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty