Individual
MARLENE ROSE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD/LD
Contact information
Practice address
419 COUNTRY LN, SAN ANTONIO, TX 78209-2320
(210) 828-5487
Mailing address
419 COUNTRY LN, SAN ANTONIO, TX 78209-2320
(210) 828-5487
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
—
—
133V00000X
Registered Dietitian
DT05210
TX
133VN1005X
Renal Nutrition Registered Dietitian
Primary
—
—
133VN1006X
Metabolic Nutrition Registered Dietitian
—
—
Other
Enumeration date
01/25/2012
Last updated
01/25/2012
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