Individual
STACY L WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
20330 HUEBNER RD, SUITE 104, SAN ANTONIO, TX 78258-3508
(832) 237-3500
(832) 237-0200
Mailing address
11321 FALLBROOK DR, HOUSTON, TX 77065-4232
(832) 237-3500
(832) 237-0200
Taxonomy
Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
855077
TX
Other
Enumeration date
04/02/2009
Last updated
04/02/2009
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