Provider Demographics
NPI:1639458292
Name:BECKER, SARAH NICHOLE (RD, LD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:NICHOLE
Last Name:BECKER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 CENTRAL PKWY N
Mailing Address - Street 2:SUITE #200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5085
Mailing Address - Country:US
Mailing Address - Phone:210-536-9591
Mailing Address - Fax:904-425-2949
Practice Address - Street 1:1860 S SEGUIN AVE
Practice Address - Street 2:BLDG E
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3914
Practice Address - Country:US
Practice Address - Phone:830-626-7770
Practice Address - Fax:855-278-4535
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DT06318133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT06318OtherTX LICENSE
TX286834ZLM2Medicare PIN