Provider Demographics
NPI:1548736325
Name:TAMEZ, VANESSA (RDN LD CDE)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:TAMEZ
Suffix:
Gender:F
Credentials:RDN LD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 WILLOW POINTE
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-2260
Mailing Address - Country:US
Mailing Address - Phone:210-978-6694
Mailing Address - Fax:
Practice Address - Street 1:121 WILLOW POINTE
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-2260
Practice Address - Country:US
Practice Address - Phone:210-978-6694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06711133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered