Healthcare Provider Details

I. General information

NPI: 1073250312
Provider Name (Legal Business Name): GIAVANA ARIEL LIMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GIAVANA ARIEL AVILES

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23931 GRASS HOOK LN
HOCKLEY TX
77447-2249
US

IV. Provider business mailing address

23931 GRASS HOOK LN
HOCKLEY TX
77447-2249
US

V. Phone/Fax

Practice location:
  • Phone: 510-512-6178
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT87405
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: