Organization
DIETGENICS NUTRITION CONSULTING LIMITED LIABILITY COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ARACELI VAZQUEZ MS, RD, LD (MEMBER)
(972) 664-0846
Entity
Organization
Contact information
Practice address
990 S SHERMAN ST, RICHARDSON, TX 75081-4845
(972) 664-0846
Mailing address
3105 LINCOLNSHIRE DR, RICHARDSON, TX 75082-4946
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT06710
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0047RS
BLUE CROSS AND BLUE SHIELD OF TEXAS
TX
05
—
2043127-01
—
TX
01
—
613657
MEDICARE PTAN
TX
Enumeration date
08/02/2011
Last updated
08/02/2011
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