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General NPI Number Information
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NPI Number | 1992170161
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Entity Type | Organization
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Legal Business Name | DIABETES AMERICA, LLC
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Dates
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Enumeration Date | 12/14/2015
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Last Update Date | 12/14/2015
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Provider Practice Location Address
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Address Line | 13100 NORTHWEST FWY
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City | HOUSTON
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State | TX
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Zip | 77040-6310
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Country | US
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Telephone | 832-237-3500
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Fax | 281-897-9906
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Provider Business Mailing Address
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Address Line | 4011 AVENUE S 1/2
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City | GALVESTON
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State | TX
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Zip | 77550-8637
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Country | US
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Telephone | 409-795-1344
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | NAKEVA TILLEY
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Credential |
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Telephone | 713-840-5153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | DT80784
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License Number State | TX
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