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NPI Code Detail

MEDICARE: MRS. STACEY BARTA RD, LD

MEDICARE: MRS. STACEY BARTA 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
1133V00000XRegistered Dietitian86086306TX

General Provider Information

NPI Number : 1760980825
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STACEY BARTA RD, LD
Provider Business Mailing Address
First Line : 3810 LAW ST APT 216
Second Line :
City : HOUSTON
State : TX
Zip : 77005-1283
Country : US
Telephone Number : 512-731-3772
Fax Number :
Provider Business Practice Location Address
First Line : 5895 SAN FELIPE ST
Second Line :
City : HOUSTON
State : TX
Zip : 77057-3061
Country : US
Telephone Number : 855-481-1149
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2018
Last Update Date : 11/19/2019

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