Provider Demographics
NPI:1689837551
Name:COSTANZA, VALERIE (MS RD LDN)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:COSTANZA
Suffix:
Gender:
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 CAMERON ST STE B1018
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3790
Mailing Address - Country:US
Mailing Address - Phone:318-254-3468
Mailing Address - Fax:
Practice Address - Street 1:2905 CAMERON ST STE B1018
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3790
Practice Address - Country:US
Practice Address - Phone:318-254-3468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2102133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered