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Individual

DR. LAURA M TABER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PHD, RD, LD

Contact information

Practice address
273 NICKLAUS DR SE, RIO RANCHO, NM 87124-3458
(505) 353-2951
Mailing address
273 NICKLAUS DR SE, RIO RANCHO, NM 87124-3458
(505) 353-2951

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD-0633
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
03-192035-00-7
NEW MEXICO TRD ID #
NM
01
80-0614609
FEDERAL ID NUMBER
Enumeration date
07/10/2010
Last updated
07/10/2010
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