Provider Demographics
NPI:1669231718
Name:ACOSTA, LAURA PAMELA (RD,LD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:PAMELA
Last Name:ACOSTA
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 1:2601 E YANDELL DR STE 104
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-3743
Mailing Address - Country:US
Mailing Address - Phone:152-626-1929
Mailing Address - Fax:833-526-6362
Practice Address - Street 1:2601 E YANDELL DR STE 104
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3743
Practice Address - Country:US
Practice Address - Phone:915-626-1929
Practice Address - Fax:833-526-6362
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT89773133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered