Provider Demographics
NPI:1477899953
Name:WALGAMA, RUWANI (RD, LD)
Entity Type:Individual
Prefix:MISS
First Name:RUWANI
Middle Name:
Last Name:WALGAMA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 WELBORN ST APT 6
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4853
Mailing Address - Country:US
Mailing Address - Phone:469-774-2552
Mailing Address - Fax:
Practice Address - Street 1:4541 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1651
Practice Address - Country:US
Practice Address - Phone:469-774-2552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06186133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered