Provider Demographics
NPI:1265795215
Name:STAGG, CHRISTINA L (RD, LD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:STAGG
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 1:605 DRAWHORN DR
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-4405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:605 DRAWHORN DR
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-4405
Practice Address - Country:US
Practice Address - Phone:409-293-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-23
Last Update Date:2023-12-13
Deactivation Date:2023-10-06
Deactivation Code:
Reactivation Date:2023-12-13
Provider Licenses
StateLicense IDTaxonomies
TXDT82137133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered