Provider Demographics
NPI:1932699246
Name:HERNANDEZ-SPINA, ELIZABETH (RD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HERNANDEZ-SPINA
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 1:1030 21ST ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-4747
Mailing Address - Country:US
Mailing Address - Phone:757-287-7933
Mailing Address - Fax:844-817-2685
Practice Address - Street 1:1030 21ST ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-4747
Practice Address - Country:US
Practice Address - Phone:757-287-7933
Practice Address - Fax:844-817-2685
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84613133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty