Provider Demographics
NPI:1629424908
Name:MENA, ELOISA (MS, RDN, LD)
Entity Type:Individual
Prefix:MS
First Name:ELOISA
Middle Name:
Last Name:MENA
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 VALLE GRANDE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3960
Mailing Address - Country:US
Mailing Address - Phone:915-253-1831
Mailing Address - Fax:
Practice Address - Street 1:2806 VALLE GRANDE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3960
Practice Address - Country:US
Practice Address - Phone:915-253-1831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83924133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered