Provider Demographics
NPI:1689923971
Name:TRAN, MIMI H (MBA, MS, RD)
Entity Type:Individual
Prefix:MS
First Name:MIMI
Middle Name:H
Last Name:TRAN
Suffix:
Gender:F
Credentials:MBA, MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3719 SHADOW WICK LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-5659
Mailing Address - Country:US
Mailing Address - Phone:281-627-8288
Mailing Address - Fax:
Practice Address - Street 1:3719 SHADOW WICK LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-5659
Practice Address - Country:US
Practice Address - Phone:281-627-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-03
Last Update Date:2013-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT03820133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT03820OtherTEXAS STATE BOARD OF EXAMINERS OF DIETITIANS