Individual
LETICIA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.,L.D.
Contact information
Practice address
211 COMAL ST, AUSTIN, TX 78702-4326
(512) 978-8130
Mailing address
1111 E CESAR CHAVEZ ST, AUSTIN, TX 78702-4209
(512) 978-8130
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT80777
TX
Other
Enumeration date
11/12/2009
Last updated
10/18/2025
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