Provider Demographics
NPI:1942967732
Name:MCINTOSH, STARLA GAIL (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:STARLA
Middle Name:GAIL
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4928 FM 2827 RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:TX
Mailing Address - Zip Code:77664-8125
Mailing Address - Country:US
Mailing Address - Phone:409-659-8353
Mailing Address - Fax:
Practice Address - Street 1:4928 FM 2827 RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:TX
Practice Address - Zip Code:77664-8125
Practice Address - Country:US
Practice Address - Phone:409-659-8353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05738133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered