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General NPI Number Information
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NPI Number | 1942662283
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Entity Type | Organization
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Legal Business Name | UP4 NUTRITION LLC
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Dates
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Enumeration Date | 03/25/2016
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Last Update Date | 07/13/2017
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Provider Practice Location Address
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Address Line | 3417 SPECTRUM BLVD
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City | RICHARDSON
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State | TX
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Zip | 75082-9705
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Country | US
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Telephone | 469-471-1988
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Fax |
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Provider Business Mailing Address
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Address Line | 4405 BOULDER DRIVE
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City | PARKER
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State | TX
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Zip | 75002
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Country | US
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Telephone | 469-471-1988
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Fax |
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Authorized Official
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Title or Position | DIETITIAN
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Name | UZMA WAHEED KHAN
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Credential | RD LD
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Telephone | 469-471-1988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | DT07722
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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