Provider Demographics
NPI:1619481017
Name:LUCIO, KARISSA CRISTINA (RD, LD)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:CRISTINA
Last Name:LUCIO
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 1:1111 E CESAR CHAVEZ ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-4209
Mailing Address - Country:US
Mailing Address - Phone:512-978-8130
Mailing Address - Fax:
Practice Address - Street 1:211 COMAL ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-4326
Practice Address - Country:US
Practice Address - Phone:512-978-8130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82850133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered