Basic Information
| Provider Information | |||||||||
| NPI: | 1649337304 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAMBERS | ||||||||
| FirstName: | EDY | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MNT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 OAK CENTRE DR | ||||||||
| Address2: | STE 320 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782583916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104943739 | ||||||||
| FaxNumber: | 2104944508 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 OAK CENTRE DR | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782583944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104943739 | ||||||||
| FaxNumber: | 2104944508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 04/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DT05740 | TX | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | DT05740 | 01 | TX | LICENSE NUMBER | OTHER |