Provider Demographics
NPI:1982020939
Name:YZQUIERDO, KATELYN (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:YZQUIERDO
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 SPRING HILL DR
Mailing Address - Street 2:SUITE 450
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-6027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:504 SPRING HILL DR
Practice Address - Street 2:SUITE 450
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-6027
Practice Address - Country:US
Practice Address - Phone:877-623-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86011625133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered