Provider Demographics
NPI:1316782501
Name:AMEZOLA VELAZQUEZ, ALEJANDRA FRIDA (RD)
Entity type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:FRIDA
Last Name:AMEZOLA VELAZQUEZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:17060 DALLAS PKWY STE 112
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1905
Mailing Address - Country:US
Mailing Address - Phone:469-372-2022
Mailing Address - Fax:833-290-5413
Practice Address - Street 1:901 S MOPAC EXPY STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5883
Practice Address - Country:US
Practice Address - Phone:737-212-9290
Practice Address - Fax:833-290-5413
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered