MEDICARE: JENNIFER RODRIGUEZ JARAMILLO R.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1004X	Pediatric Nutrition Registered Dietitian	DT84672	TX
2	133V00000X	Registered Dietitian	#DT84672	TX

General Provider Information

NPI Number	:	1285174524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RODRIGUEZ JARAMILLO R.D.

Provider Business Mailing Address
First Line	:	9800 HILLWOOD PKWY STE 140
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-1532
Country	:	US
Telephone Number	:	682-478-4130
Fax Number	:

Provider Business Practice Location Address
First Line	:	9800 HILLWOOD PKWY STE 140
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-1532
Country	:	US
Telephone Number	:	682-478-4130
Fax Number	:	140-855-3951

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2017
Last Update Date	:	04/06/2021

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