Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 14505 | TX |
NPI | 1336737105 |
---|---|
Provider Name | Dr. Taylor Luster |
First Address | San Antonio, TX 78259-3664 |
Second Address | San Antonio, TX 78259-7606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2021 |
Last Update Date | 06/01/2021 |