Provider Demographics
NPI:1871198978
Name:MOPSIK, MARIE C (RDN, CDCES)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:C
Last Name:MOPSIK
Suffix:
Gender:F
Credentials:RDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12721 CAPELLA TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-2396
Mailing Address - Country:US
Mailing Address - Phone:512-736-7156
Mailing Address - Fax:
Practice Address - Street 1:12721 CAPELLA TRL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-2396
Practice Address - Country:US
Practice Address - Phone:512-736-7156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17626133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered