Provider Demographics
NPI:1184339384
Name:RAVEN, DULCE MAGDALENA (RDN)
Entity type:Individual
Prefix:
First Name:DULCE
Middle Name:MAGDALENA
Last Name:RAVEN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:DULCE
Other - Middle Name:MAGDALENA
Other - Last Name:VELASQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:3505 SANTA SOFIA ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3505 SANTA SOFIA ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-7536
Practice Address - Country:US
Practice Address - Phone:956-249-3941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86050078133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered