Provider Demographics
NPI:1154808509
Name:BLAND, RACHEL (RD, LD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BLAND
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 1:1742 DONERAIL ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-1127
Mailing Address - Country:US
Mailing Address - Phone:210-748-4161
Mailing Address - Fax:
Practice Address - Street 1:400 N LOOP 1604 E STE 175
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1231
Practice Address - Country:US
Practice Address - Phone:210-545-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86019206133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z137Medicaid