Organization
J & T PARK ENTERPRISES, LTD.
Active
Organization
J & T PARK ENTERPRISES, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VICTORIA CUCCIA PARK R.D. L.D. (REGISTERED DIETITIAN)
(806) 341-8883
Entity
Organization
Contact information
Practice address
788 COOKS CORNER RD, POTTSBORO, TX 75076-6042
(806) 341-8883
Mailing address
788 COOKS CORNER RD, POTTSBORO, TX 75076-6042
(806) 341-8883
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT04601
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356573166
—
TX
01
—
TXB154636
MEDICARE PTAN
TX
Enumeration date
06/21/2012
Last updated
08/13/2012
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