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Individual

SUSAN BANUELOS SMITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS RD LD CDE

Contact information

Practice address
5308 N GALLOWAY AVE STE 200, MESQUITE, TX 75150-1125
(214) 358-2300
(214) 579-6754
Mailing address
447 LAKEDALE DR, MURPHY, TX 75094-4289
(469) 734-0822

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT05851
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
DT05851
REGISTERED DIETITIAN
TX
Enumeration date
05/29/2018
Last updated
09/23/2022
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