Provider Demographics
NPI:1043347347
Name:LOOP, JEANNE H (REGISTERES DIETITIAN)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:H
Last Name:LOOP
Suffix:
Gender:F
Credentials:REGISTERES DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-3117
Mailing Address - Country:US
Mailing Address - Phone:210-334-3700
Mailing Address - Fax:210-922-0162
Practice Address - Street 1:315 N SAN SABA
Practice Address - Street 2:STE. 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3154
Practice Address - Country:US
Practice Address - Phone:210-738-8222
Practice Address - Fax:210-738-8644
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT02956133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166298301Medicaid
TX94531OtherCARELINK
TXP72084Medicare UPIN
TX166298301Medicaid