Provider Demographics
NPI:1902387814
Name:VALLEJO, KAREN ANNETTE (RD LD)
Entity Type:Individual
Prefix:MISS
First Name:KAREN
Middle Name:ANNETTE
Last Name:VALLEJO
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7641 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2038
Mailing Address - Country:US
Mailing Address - Phone:956-251-2965
Mailing Address - Fax:
Practice Address - Street 1:1911 NE BOB BULLOCK LOOP
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6596
Practice Address - Country:US
Practice Address - Phone:956-712-8053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85562133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered