Provider Demographics
NPI:1457974941
Name:GAITAN, VERONICA A (NUTRITIONIST, IBCLC)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:A
Last Name:GAITAN
Suffix:
Gender:F
Credentials:NUTRITIONIST, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 JAY AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3921
Mailing Address - Country:US
Mailing Address - Phone:956-331-5955
Mailing Address - Fax:
Practice Address - Street 1:2100 JAY AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3921
Practice Address - Country:US
Practice Address - Phone:956-331-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 133NN1002X
L-24746174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education