Provider Demographics
NPI:1144784752
Name:MARIA MENDOZA RD, LLC
Entity type:Organization
Organization Name:MARIA MENDOZA RD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LD, CDCES
Authorized Official - Phone:512-967-3388
Mailing Address - Street 1:3432 GREYSTONE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-2371
Mailing Address - Country:US
Mailing Address - Phone:512-967-3388
Mailing Address - Fax:844-288-5514
Practice Address - Street 1:3432 GREYSTONE DR STE 120
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-2371
Practice Address - Country:US
Practice Address - Phone:512-967-3388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty