Healthcare Provider Details

I. General information

NPI: 1851617955
Provider Name (Legal Business Name): ANGILINA GARDI RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 CARLISLE ST SUITE 200
DALLAS TX
75204-1084
US

IV. Provider business mailing address

2929 CARLISLE ST SUITE 200
DALLAS TX
75204-1084
US

V. Phone/Fax

Practice location:
  • Phone: 214-348-5557
  • Fax: 214-348-5898
Mailing address:
  • Phone: 214-348-5557
  • Fax: 214-348-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT07420
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: