Provider Demographics
NPI:1578192456
Name:FAROOKI, JUHINA (MPH, RD, LD)
Entity Type:Individual
Prefix:
First Name:JUHINA
Middle Name:
Last Name:FAROOKI
Suffix:
Gender:F
Credentials:MPH, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 PINE FOREST DR STE 701
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-5317
Mailing Address - Country:US
Mailing Address - Phone:346-418-9642
Mailing Address - Fax:713-513-5524
Practice Address - Street 1:150 PINE FOREST DR STE 701
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-5317
Practice Address - Country:US
Practice Address - Phone:346-418-9642
Practice Address - Fax:713-513-5524
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84786133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX28428481OtherSTATE LICENCE