=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629776570
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POWERD NUTRITION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2023
-----------------------------------------------------
Last Update Date | 02/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2223 HAWES AVE APT 479
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75235-4693
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-267-0100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2223 HAWES AVE APT 479
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75235-4693
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-267-0100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | SADAF RAMAZANI
-----------------------------------------------------
Credential | RD
-----------------------------------------------------
Telephone | 318-267-0100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133VN1301X
-----------------------------------------------------
Taxonomy Name | Oncology Nutrition Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------