MEDICARE: MISS TRINA I BOLAND DIETITIAN

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	133N00000X	Nutritionist	DT05574	TX

General Provider Information

NPI Number	:	1750492229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TRINA I BOLAND DIETITIAN

Provider Business Mailing Address
First Line	:	1302 N SHEPHERD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-3752
Country	:	US
Telephone Number	:	713-696-3131
Fax Number	:	713-696-2133

Provider Business Practice Location Address
First Line	:	300 W LITTLE YORK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77076-1303
Country	:	US
Telephone Number	:	713-696-3131
Fax Number	:	713-696-2133

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/26/2010

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Directions to “ MISS TRINA I BOLAND DIETITIAN” Practice Location

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