Provider Demographics
NPI:1407495179
Name:ZAIDI, WAHIDA (RD)
Entity Type:Individual
Prefix:
First Name:WAHIDA
Middle Name:
Last Name:ZAIDI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CORNWALL DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-2219
Mailing Address - Country:US
Mailing Address - Phone:720-272-7931
Mailing Address - Fax:
Practice Address - Street 1:420 E 6TH ST # 106107
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4529
Practice Address - Country:US
Practice Address - Phone:720-272-7931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL950737133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered