Provider Demographics
NPI:1124576657
Name:MISTRY, PUJA RAMESH
Entity Type:Individual
Prefix:
First Name:PUJA
Middle Name:RAMESH
Last Name:MISTRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 FOXGLOVE DR
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-4529
Mailing Address - Country:US
Mailing Address - Phone:512-987-2854
Mailing Address - Fax:
Practice Address - Street 1:225 FOXGLOVE DR
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-4529
Practice Address - Country:US
Practice Address - Phone:512-987-2854
Practice Address - Fax:855-710-7869
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83610133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered