Provider Demographics
NPI:1215168638
Name:LUBRITZ, PAIGE (RD LD)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:LUBRITZ
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 1:815A BRAZOS ST STE 210
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2502
Mailing Address - Country:US
Mailing Address - Phone:512-350-6840
Mailing Address - Fax:
Practice Address - Street 1:815A BRAZOS ST STE 210
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2502
Practice Address - Country:US
Practice Address - Phone:512-350-6840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06923133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered