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General NPI Number Information
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NPI Number | 1710145958
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Entity Type | Individual
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Provider Name | FAHIMAH YAZDANFARD CALLAHAN RD
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Gender | Female
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Dates
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Enumeration Date | 05/23/2008
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 14832 MAIN ST. USRENAL CARETRI-COUNTY DIALYSIS
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City | LYTLE
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State | TX
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Zip | 78052
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Country | US
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Telephone | 830-772-5784
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Fax | 830-772-5793
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Provider Business Mailing Address
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Address Line | 14 KNIGHTS PEAK
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City | SAN ANTONIO
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State | TX
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Zip | 78254-2511
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Country | US
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Telephone | 210-872-6105
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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 | DT 80799
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License Number State | TX
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