Provider Demographics
NPI:1992139521
Name:GIL, ANGELA (RD, LD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GIL
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 1:12000 DESSAU RD
Mailing Address - Street 2:#1128
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-2084
Mailing Address - Country:US
Mailing Address - Phone:512-815-7377
Mailing Address - Fax:
Practice Address - Street 1:12000 DESSAU RD
Practice Address - Street 2:#1128
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-2084
Practice Address - Country:US
Practice Address - Phone:512-815-7377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81715133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered