Provider Demographics
NPI:1104481613
Name:CAPURRO-REEVE, RANDAHL (RDN, LD)
Entity type:Individual
Prefix:MR
First Name:RANDAHL
Middle Name:
Last Name:CAPURRO-REEVE
Suffix:
Gender:M
Credentials:RDN, LD
Other - Prefix:MR
Other - First Name:RANDY
Other - Middle Name:
Other - Last Name:CAPURRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN, LD
Mailing Address - Street 1:8039 BIG BND
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-2842
Mailing Address - Country:US
Mailing Address - Phone:210-446-8568
Mailing Address - Fax:
Practice Address - Street 1:8039 BIG BND
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-2842
Practice Address - Country:US
Practice Address - Phone:210-446-8568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84564133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty