Provider Demographics
NPI:1790173946
Name:OSORNIO, LAURA (RD, LD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:OSORNIO
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LD
Mailing Address - Street 1:7150 E GRAND AVE APT 1109
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75223-3662
Mailing Address - Country:US
Mailing Address - Phone:214-202-8822
Mailing Address - Fax:
Practice Address - Street 1:2777 N STEMMONS FWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207-2277
Practice Address - Country:US
Practice Address - Phone:214-456-3501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83428133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered