Individual
MS. CYNTHIA K. GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ED DIETITIAN
Contact information
Practice address
1110 N SARAH DEWITT DR, GONZALES, TX 78629-3311
(830) 672-7581
(830) 672-2401
Mailing address
1110 N SARAH DEWITT DR, GONZALES, TX 78629-3311
(830) 672-7581
(830) 672-2401
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
862948
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00L70B
MEDICARE GROUP NUMBER
TX
05
—
3460982
—
TX
01
—
862948
DIETETIC REGISTRATION
TX
01
—
DT05451
LICENSED DIETITIAN
TX
Enumeration date
09/06/2006
Last updated
12/28/2016
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