Provider Demographics
NPI:1811272396
Name:CHAVEZ, LAURA T (MS, RD,LD)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:T
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:MS, RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 DEMONA CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78733-1681
Mailing Address - Country:US
Mailing Address - Phone:512-638-0310
Mailing Address - Fax:512-697-9307
Practice Address - Street 1:9601 DEMONA CV
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78733-1681
Practice Address - Country:US
Practice Address - Phone:512-638-0310
Practice Address - Fax:512-697-9307
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06971133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered