Provider Demographics
NPI:1710608617
Name:CAMBUI MILHOMENS, MATEUS (RDN, LD, MS, IBCLC)
Entity Type:Individual
Prefix:
First Name:MATEUS
Middle Name:
Last Name:CAMBUI MILHOMENS
Suffix:
Gender:M
Credentials:RDN, LD, MS, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 PARK GROVE DR STE 720
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-1577
Mailing Address - Country:US
Mailing Address - Phone:713-997-9613
Mailing Address - Fax:713-903-7918
Practice Address - Street 1:411 PARK GROVE DR STE 720
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1577
Practice Address - Country:US
Practice Address - Phone:713-997-9613
Practice Address - Fax:713-903-7918
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT88013133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered