Provider Demographics
NPI:1689135311
Name:BOURGEOIS, DANIELLE (RDN, CEDRD, LD)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:RDN, CEDRD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 LOOP 337
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3521
Mailing Address - Country:US
Mailing Address - Phone:830-660-7037
Mailing Address - Fax:
Practice Address - Street 1:1852 LOCKHILL SELMA RD STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1500
Practice Address - Country:US
Practice Address - Phone:830-660-7037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83876133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered