Provider Demographics
NPI:1306121231
Name:TOVAR, AMANDA CELINE (RD, LD)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:CELINE
Last Name:TOVAR
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 1:5525 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-5563
Mailing Address - Country:US
Mailing Address - Phone:956-362-5650
Mailing Address - Fax:956-362-5664
Practice Address - Street 1:5525 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5563
Practice Address - Country:US
Practice Address - Phone:956-362-5650
Practice Address - Fax:956-362-5664
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82058133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB166239Medicare PIN