Healthcare Provider Details

I. General information

NPI: 1336344969
Provider Name (Legal Business Name): DESIREE JAMIE HEINTZ M.S., R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MOTOR ST
DALLAS TX
75235-7701
US

IV. Provider business mailing address

4225 THREADGILL ST
AUSTIN TX
78723-4548
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-7000
  • Fax:
Mailing address:
  • Phone: 214-676-0036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDT07486
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: