Provider Demographics
NPI:1255505566
Name:VAZQUEZ NUTRITION AND VIDA, ARACELI (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:ARACELI
Middle Name:
Last Name:VAZQUEZ NUTRITION AND VIDA
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 RAVEN DR
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-3907
Mailing Address - Country:US
Mailing Address - Phone:972-664-0846
Mailing Address - Fax:972-744-0726
Practice Address - Street 1:1221 ABRAMS RD STE 210
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5578
Practice Address - Country:US
Practice Address - Phone:972-664-0846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06710133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2043127-02Medicaid
TX613657OtherMEDICARE PTAN
TX01309466OtherAMERIGROUP
TX2043127-01Medicaid