Healthcare Provider Details

I. General information

NPI: 1992100481
Provider Name (Legal Business Name): INSHAALLAH HEPHZIBAH RDN, LD L.L.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 RIO VISTA LN
ARLINGTON TX
76017-1753
US

IV. Provider business mailing address

9900 SPECTRUM DR
AUSTIN TX
78717-4555
US

V. Phone/Fax

Practice location:
  • Phone: 817-690-9298
  • Fax:
Mailing address:
  • Phone: 817-690-9298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberDT82667
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: