Healthcare Provider Details

I. General information

NPI: 1740590504
Provider Name (Legal Business Name): RONNIE CUMMINGS RD, LD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3224 YOAKUM BLVD
HOUSTON TX
77006-3926
US

IV. Provider business mailing address

PO BOX 541635
HOUSTON TX
77254-1635
US

V. Phone/Fax

Practice location:
  • Phone: 713-520-5288
  • Fax:
Mailing address:
  • Phone: 713-252-4767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number803328
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: