MEDICARE: MS. ANABELIA AGUILLON RDN, LD, CDCES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86012018	TX

General Provider Information

NPI Number	:	1043828403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANABELIA AGUILLON RDN, LD, CDCES

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:	254-724-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 SPRING AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75210-1350
Country	:	US
Telephone Number	:	214-865-3067
Fax Number	:	214-865-6250

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2020
Last Update Date	:	08/19/2020

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