1881015113 NPI number — ALICIA ELENA FARHAT MPH, RD, LD

Table of content: CHRISTINE HIGHFILL LCPC (NPI 1134469034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881015113 NPI number — ALICIA ELENA FARHAT MPH, RD, LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARHAT
Provider First Name:
ALICIA
Provider Middle Name:
ELENA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPH, RD, LD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1881015113
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
714 LIBERTY ST APT 2812
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75204-8716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-588-9532
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1935 MEDICAL DISTRICT DR
Provider Second Line Business Practice Location Address:
CLINICAL NUTRITION
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75235-7701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-456-3264
Provider Business Practice Location Address Fax Number:
214-456-6287
Provider Enumeration Date:
01/06/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133VN1004X , with the licence number:  1039352 , 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: DT82916 . This is a "LICENSED DIETITIAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1039352 . This is a "REGISTERED DIETITIAN, REGISTERED DIETITIAN NUTRITIONIST" identifier . This identifiers is of the category "OTHER".