MEDICARE: NAVIN HARIPRASAD RD/LD

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	DT81846	TX

General Provider Information

NPI Number	:	1104119643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAVIN HARIPRASAD RD/LD

Provider Business Mailing Address
First Line	:	1512 COMMERCE ST
Second Line	:	517
City	:	DALLAS
State	:	TX
Zip	:	75201-4917
Country	:	US
Telephone Number	:	972-839-5643
Fax Number	:

Provider Business Practice Location Address
First Line	:	1512 COMMERCE ST
Second Line	:	517
City	:	DALLAS
State	:	TX
Zip	:	75201-4917
Country	:	US
Telephone Number	:	972-839-5643
Fax Number	:

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

Provider Enumeration Date	:	05/17/2011
Last Update Date	:	05/17/2011

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