Healthcare Provider Details

I. General information

NPI: 1376755058
Provider Name (Legal Business Name): KARAN KAY DALGAS RD,LD,CSR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6358 SO. 80TH E. AVE. APT. G
TULSA OK
74133
US

IV. Provider business mailing address

6358 SO. 80TH E. AVE. APT. G
TULSA OK
74133
US

V. Phone/Fax

Practice location:
  • Phone: 918-250-7689
  • Fax:
Mailing address:
  • Phone: 918-250-7689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number865
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: