Individual
DONOVAN MAYCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NUTRITIONIST
Contact information
Practice address
16610 SAN PEDRO AVENUE, SAN ANTONIO, TX 78232
(210) 778-4781
(210) 545-0444
Mailing address
16610 SAN PEDRO AVENUE, SAN ANTONIO, TX 78232
(210) 778-4781
(210) 545-0444
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12138706
CAQH
—
01
—
67752
AMERICAN FITNESS PROFESSIONALS ASSOCIATION- CERTIFIED NUTRITION AND WELLNESS
—
Enumeration date
10/12/2011
Last updated
10/12/2011
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