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General NPI Number Information
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NPI Number | 1942687322
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Entity Type | Organization
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Legal Business Name | STREAM OF LIFE
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Dates
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Enumeration Date | 05/05/2015
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 400 MAPLELAWN DR SUITE 101
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City | PLANO
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State | TX
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Zip | 75075-5743
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Country | US
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Telephone | 214-448-3318
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Fax |
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Provider Business Mailing Address
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Address Line | 400 MAPLELAWN DRIVE SUITE 101
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City | PLANO
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State | TX
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Zip | 75075
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Country | US
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Telephone | 214-448-3318
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Fax |
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Authorized Official
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Title or Position | CLINICAL NUTRITIONIST
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Name | DR. XUEJUN ZHANG
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Credential | CCN, PH.D
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Telephone | 214-448-3318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 5004
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License Number State | TX
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