Provider Demographics
NPI:1841592219
Name:SAENZ, AMANDA VILLARREAL (RD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:VILLARREAL
Last Name:SAENZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 CORNERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8472
Mailing Address - Country:US
Mailing Address - Phone:956-668-1203
Mailing Address - Fax:956-668-1462
Practice Address - Street 1:2215 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8472
Practice Address - Country:US
Practice Address - Phone:956-668-1203
Practice Address - Fax:956-668-1462
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX933303133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX933303OtherCOMMISSION ON DIETETIC REGISTRATION
TXDT06559OtherTEXAS STATE BOARD OF EXAMINERS OF DIETITIANS