Provider Demographics
NPI:1629777271
Name:MEJIA RODRIGUEZ, FERNANDO (RD, LD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:MEJIA RODRIGUEZ
Suffix:
Gender:M
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 1:6410 FANNIN ST STE 470
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3008
Mailing Address - Country:US
Mailing Address - Phone:713-486-6961
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST STE 470
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3008
Practice Address - Country:US
Practice Address - Phone:713-486-6961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT88295133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered