Provider Demographics
NPI:1588809966
Name:MOTA, URMILA (MS,RD,LD)
Entity Type:Individual
Prefix:MRS
First Name:URMILA
Middle Name:
Last Name:MOTA
Suffix:
Gender:F
Credentials:MS,RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 CAMERON RUN TER APT 1511
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-2711
Mailing Address - Country:US
Mailing Address - Phone:601-842-3906
Mailing Address - Fax:
Practice Address - Street 1:330 NORTH MART PLAZA, SUITE 3
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206
Practice Address - Country:US
Practice Address - Phone:601-842-3906
Practice Address - Fax:601-607-3404
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD0248133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered