Healthcare Provider Details

I. General information

NPI: 1376125112
Provider Name (Legal Business Name): DIETITIANS OF DALLAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 04/21/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 CHASE OAKS BLVD STE 150
PLANO TX
75023-2383
US

IV. Provider business mailing address

6600 CHASE OAKS BLVD STE 150
PLANO TX
75023-2383
US

V. Phone/Fax

Practice location:
  • Phone: 469-939-1047
  • Fax:
Mailing address:
  • Phone: 469-939-1047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: ANDREA LUONGO
Title or Position: OWNER
Credential: RD
Phone: 469-939-1047