Provider Demographics
NPI:1376575944
Name:DE FREITAS, RITA MARIE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:MARIE
Last Name:DE FREITAS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:MARIE
Other - Last Name:EDMONDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:4057 RILEY FUZZEL RD STE 500-203
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-4632
Mailing Address - Country:US
Mailing Address - Phone:124-779-1280
Mailing Address - Fax:
Practice Address - Street 1:105 MAPLE DR
Practice Address - Street 2:
Practice Address - City:WARRENDALE
Practice Address - State:PA
Practice Address - Zip Code:15086-7590
Practice Address - Country:US
Practice Address - Phone:724-814-0247
Practice Address - Fax:724-933-1916
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003348133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101657738Medicaid
PA101657738Medicaid
PAQ57149Medicare UPIN