=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689445926
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEMA CHERUKOORU RD, LD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2024
-----------------------------------------------------
Last Update Date | 02/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 921 W NEW HOPE DR STE 203
-----------------------------------------------------
City | CEDAR PARK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78613-6785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-422-4698
-----------------------------------------------------
Fax | 512-617-9125
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2301 BAGDAD RD STE 404
-----------------------------------------------------
City | CEDAR PARK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78613-6519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-591-3640
-----------------------------------------------------
Fax | 210-209-8250
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 86292114
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------