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NPI 1629137567

NPI 1629137567 : ANJANI UPPONI RD LD : DALLAS, TX

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General NPI Number Information
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    NPI Number           |    1629137567
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    Entity Type          |    Individual 
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    Provider Name        |    ANJANI UPPONI RD LD
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    12/06/2006
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    Last Update Date     |    04/30/2013
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Provider Practice Location Address
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    Address Line         |    5959 ROYAL LN STE 515 
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    City                 |    DALLAS
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    State                |    TX
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    Zip                  |    75230-3890
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    Country              |    US
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    Telephone            |    214-373-5305
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    2202 THORNBURY LN 
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    City                 |    ALLEN
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    State                |    TX
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    Zip                  |    75013-5360
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    Country              |    US
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    Telephone            |    
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    Fax                  |    
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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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       |    DT07626
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    License Number State |    TX
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