Healthcare Provider Details

I. General information

NPI: 1437028487
Provider Name (Legal Business Name): RACHEL DZAKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28911 CHAMPION OAKS DR
MAGNOLIA TX
77354-5545
US

IV. Provider business mailing address

28911 CHAMPION OAKS DR
MAGNOLIA TX
77354-5545
US

V. Phone/Fax

Practice location:
  • Phone: 717-712-2352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT86305
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: