Provider Demographics
NPI:1578335238
Name:INSHAALLAH HEPHZIBAH RDN, LD L.L.C.
Entity Type:Organization
Organization Name:INSHAALLAH HEPHZIBAH RDN, LD L.L.C.
Other - Org Name:INSHAALLAH HEPHZIBAH-EVANS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:RENAL DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:INSHAALLAH
Authorized Official - Middle Name:ADE
Authorized Official - Last Name:HEPHZIBAH
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD
Authorized Official - Phone:817-690-9298
Mailing Address - Street 1:9900 SPECTRUM DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4555
Mailing Address - Country:US
Mailing Address - Phone:817-690-9298
Mailing Address - Fax:
Practice Address - Street 1:930 RIO VISTA LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1753
Practice Address - Country:US
Practice Address - Phone:817-690-9298
Practice Address - Fax:817-549-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Single Specialty