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General NPI Number Information
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NPI Number | 1457761488
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Entity Type | Organization
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Legal Business Name | ROSS ENTERPRISE
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 12/26/2019
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Provider Practice Location Address
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Address Line | 1106 CLAYTON LN SUITE 517W
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City | AUSTIN
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State | TX
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Zip | 78723-1066
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Country | US
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Telephone | 512-212-4601
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Fax |
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Provider Business Mailing Address
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Address Line | 3839 BRIARGROVE LN APT 2303
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City | DALLAS
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State | TX
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Zip | 75287-6367
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Country | US
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Telephone | 502-594-0020
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL ROSS
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Credential |
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Telephone | 502-594-0020
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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 | DT01993
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License Number State | TX
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