Provider Demographics
NPI:1578592432
Name:BONNETTE, REGINA K (RD)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:K
Last Name:BONNETTE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:REGINA
Other - Middle Name:K
Other - Last Name:DICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:127 SABLE HTS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4879
Mailing Address - Country:US
Mailing Address - Phone:903-530-1719
Mailing Address - Fax:
Practice Address - Street 1:127 SABLE HTS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4879
Practice Address - Country:US
Practice Address - Phone:903-530-1719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05033133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP55437Medicaid
99437Medicare UPIN
TXP55437Medicaid