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General NPI Number Information
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NPI Number | 1376125112
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Entity Type | Organization
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Legal Business Name | DIETITIANS OF DALLAS, LLC
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Dates
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Enumeration Date | 04/21/2021
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Last Update Date | 04/21/2021
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Provider Practice Location Address
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Address Line | 6600 CHASE OAKS BLVD STE 150
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City | PLANO
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State | TX
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Zip | 75023-2383
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Country | US
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Telephone | 469-939-1047
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Fax |
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Provider Business Mailing Address
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Address Line | 6600 CHASE OAKS BLVD STE 150
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City | PLANO
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State | TX
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Zip | 75023-2383
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Country | US
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Telephone | 469-939-1047
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREA LUONGO
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Credential | RD
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Telephone | 469-939-1047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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