Provider Demographics
NPI:1205138062
Name:ROSENBERG, TANYA L (RD, LD)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:L
Last Name:ROSENBERG
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 1:2018 E BUSINESS HIGHWAY 83
Mailing Address - Street 2:SUITE 312
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-9206
Mailing Address - Country:US
Mailing Address - Phone:956-537-1916
Mailing Address - Fax:
Practice Address - Street 1:2018 E BUSINESS HIGHWAY 83
Practice Address - Street 2:SUITE 312
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-9206
Practice Address - Country:US
Practice Address - Phone:956-537-1916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81529133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT81529OtherLICENSE DIETITIAN