Provider Demographics
NPI:1710619275
Name:QUEVEDO, PRISCILA VERONICA (RD)
Entity Type:Individual
Prefix:
First Name:PRISCILA
Middle Name:VERONICA
Last Name:QUEVEDO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 JOE BATTLE BLVD STE E-G
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-2609
Mailing Address - Country:US
Mailing Address - Phone:915-642-9444
Mailing Address - Fax:915-800-8570
Practice Address - Street 1:2270 JOE BATTLE BLVD STE E-G
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2609
Practice Address - Country:US
Practice Address - Phone:915-642-9444
Practice Address - Fax:915-800-8570
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT94406133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT94406OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION
TX86023099OtherCOMMISION ON DIETETIC REGISTRATION