Provider Demographics
NPI:1124429121
Name:GUILLAUME, MIKALA (RD, LD)
Entity type:Individual
Prefix:
First Name:MIKALA
Middle Name:
Last Name:GUILLAUME
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MRS
Other - First Name:MIKALA
Other - Middle Name:
Other - Last Name:SESSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LD
Mailing Address - Street 1:8521 CHEYENNE BLUFF
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109
Mailing Address - Country:US
Mailing Address - Phone:210-323-5010
Mailing Address - Fax:
Practice Address - Street 1:1655 HIGHWAY 46 WEST
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132
Practice Address - Country:US
Practice Address - Phone:210-323-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT8307133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered