MEDICARE: YOUTRITION

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	DT07116	TX

General Provider Information

NPI Number	:	1144559105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUTRITION

Provider Business Mailing Address
First Line	:	3336 SPRING MOUNTAIN DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-3953
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3336 SPRING MOUNTAIN DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-3953
Country	:	US
Telephone Number	:	214-732-9680
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER/OWNER
Name	:	MISS NAVEENA REDDY
Credential	:	RD, CDE, MS
Telephone Number	:	214-732-9680

Provider Enumeration Date	:	12/21/2009
Last Update Date	:	12/21/2009

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Directions to “YOUTRITION ” Practice Location

Language	Start Address	Practice Location

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