Basic Information
| Provider Information | |||||||||
| NPI: | 1881939130 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ULLOA | ||||||||
| FirstName: | JOHANNA | ||||||||
| MiddleName: | CUESTA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LD, RD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CUESTA | ||||||||
| OtherFirstName: | JOHANNA | ||||||||
| OtherMiddleName: | MARCELA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1210 W BRAKER LN | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787583801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1210 W BRAKER LN | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787583801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789300 | ||||||||
| FaxNumber: | 5129019737 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2012 | ||||||||
| LastUpdateDate: | 04/16/2019 | ||||||||
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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 | DT85850 | TX | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | 1101653 | NV | N | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.