Basic Information
| Provider Information | |||||||||
| NPI: | 1275194698 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEPULVEDA-STOLL | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | MELISSA | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12617 DRINGENBERG DR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787297784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102162994 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6835 AUSTIN CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787313189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123466611 | ||||||||
| FaxNumber: | 5124067315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2019 | ||||||||
| LastUpdateDate: | 06/26/2019 | ||||||||
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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 | DT83113 | TX | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.