MEDICARE: JOYCE GUILHERMINO ABREU RD

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	DT84745	TX

General Provider Information

NPI Number	:	1417481169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCE GUILHERMINO ABREU RD

Provider Business Mailing Address
First Line	:	5107 VICKERY BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-6224
Country	:	US
Telephone Number	:	508-617-9522
Fax Number	:

Provider Business Practice Location Address
First Line	:	5107 VICKERY BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-6224
Country	:	US
Telephone Number	:	508-617-9522
Fax Number	:

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

Provider Enumeration Date	:	04/19/2017
Last Update Date	:	04/19/2017

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