Miranda Leigh Castillo, RDN, CDE
Individual provider Active NPI Registered Dietitian · Selma, TX
NPI 1659889152 · NPPES record last updated Mar 25, 2020
Key facts
- NPI
- 1659889152
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- DT84930 (TX)
- Practice address
- 16111 Ike LN
Selma, TX 78154-1154 - Phone
- (361) 813-8810
- NPI assigned
- Jan 18, 2018
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT84930 | TX | MD | Registered Dietitian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DT84930 | TX | Yes |
Addresses
Primary practice location
16111 Ike LN
Selma, TX 78154-1154
Mailing address
16111 Ike LN
Selma, TX 78154-1154
Phone (361) 813-8810
Other providers in Selma, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.