Provider Demographics
NPI:1992824767
Name:ALBARADO, MARY L (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:ALBARADO
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:L
Other - Last Name:ALBARADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, CDE
Mailing Address - Street 1:2222 MORGAN AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-1993
Mailing Address - Country:US
Mailing Address - Phone:361-882-5417
Mailing Address - Fax:
Practice Address - Street 1:2222 MORGAN AVE STE 113
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1993
Practice Address - Country:US
Practice Address - Phone:361-882-5417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT01160133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
09710002OtherCERTIFIED DIABETES EDUCATOR
TXDT01160OtherSTATE LIC.
R383258OtherREGISTERED DIETITIAN