Provider Demographics
NPI:1780022491
Name:TEXAS A&M HEALTH SCIENCE CENTER-COASTAL BEND HEALTH EDUCATION CENTER
Entity Type:Organization
Organization Name:TEXAS A&M HEALTH SCIENCE CENTER-COASTAL BEND HEALTH EDUCATION CENTER
Other - Org Name:COASTAL BEND HEALTH EDUCATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FOR FINANCE & ADMINISTRATION
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:979-436-9202
Mailing Address - Street 1:6300 OCEAN DRIVE
Mailing Address - Street 2:NRC 3500, UNIT 5861
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-5861
Mailing Address - Country:US
Mailing Address - Phone:361-825-2804
Mailing Address - Fax:361-825-2809
Practice Address - Street 1:4101 OLD BROWNSVILLE ROAD
Practice Address - Street 2:HS1 BUILDING, SUITE 262
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405
Practice Address - Country:US
Practice Address - Phone:361-857-2945
Practice Address - Fax:361-857-2963
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS A&M HEALTH SCIENCE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty