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NPI Code Detail

MEDICARE: CLAIRE POND GUNDLACH MS, RDN, LD

MEDICARE: CLAIRE POND GUNDLACH MS, RDN, 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
1133V00000XRegistered Dietitian86071548TX

General Provider Information

NPI Number : 1407359714
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLAIRE POND GUNDLACH MS, RDN, LD
Provider Business Mailing Address
First Line : 2217 IVAN ST APT 924
Second Line :
City : DALLAS
State : TX
Zip : 75201-7038
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 422 E LAMAR BLVD STE 108
Second Line :
City : ARLINGTON
State : TX
Zip : 76011-3604
Country : US
Telephone Number : 817-751-7802
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2018
Last Update Date : 03/13/2018

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