Provider Demographics
NPI:1659813830
Name:THOMPSON MURILLO, RUTH L (RD, LD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:L
Last Name:THOMPSON MURILLO
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:
Other - Last Name:MURILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LD
Mailing Address - Street 1:512 LAMAR ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-3782
Mailing Address - Country:US
Mailing Address - Phone:817-566-1025
Mailing Address - Fax:
Practice Address - Street 1:512 LAMAR ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-3782
Practice Address - Country:US
Practice Address - Phone:817-566-1025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-05
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84293133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered