Provider Demographics
NPI:1194732321
Name:LLERANDI PHIPPS, CARMEN G (MPH,RD,LD,AHCFA)
Entity type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:G
Last Name:LLERANDI PHIPPS
Suffix:
Gender:F
Credentials:MPH,RD,LD,AHCFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 ACACIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552
Mailing Address - Country:US
Mailing Address - Phone:951-233-0026
Mailing Address - Fax:
Practice Address - Street 1:5810 ACACIA DRIVE
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552
Practice Address - Country:US
Practice Address - Phone:951-233-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 133NN1002X
716372133V00000X
TXDT81023133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered