Provider Demographics
NPI:1114430881
Name:PARRA, MIRTA YOLANDA (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:MIRTA
Middle Name:YOLANDA
Last Name:PARRA
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:MIRTA
Other - Middle Name:YOLANDA
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1505 LBJ FWY STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6065
Mailing Address - Country:US
Mailing Address - Phone:214-358-2300
Mailing Address - Fax:214-579-6941
Practice Address - Street 1:1250 8TH AVE STE 135
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4156
Practice Address - Country:US
Practice Address - Phone:817-923-8050
Practice Address - Fax:214-579-6993
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82888133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT82888OtherREGISTERED DIETITIAN