1811158025 NPI number — MASTERS IN DIETETICS, L.L.C.

Table of content: (NPI 1811158025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811158025 NPI number — MASTERS IN DIETETICS, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASTERS IN DIETETICS, L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811158025
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10101 FONDREN RD
Provider Second Line Business Mailing Address:
STE 331
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77096-5126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-532-7623
Provider Business Mailing Address Fax Number:
832-532-4311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10101 FONDREN RD
Provider Second Line Business Practice Location Address:
STE 331
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77096-5126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-532-7623
Provider Business Practice Location Address Fax Number:
832-532-4311
Provider Enumeration Date:
06/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LENOX
Authorized Official First Name:
TABITHA
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
844-532-7623

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  DT80655 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3717530-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3717530-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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