Provider Demographics
NPI:1720543648
Name:RIAZ, RUKHAMA (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:RUKHAMA
Middle Name:
Last Name:RIAZ
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 TARRAGON BEND DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-2618
Mailing Address - Country:US
Mailing Address - Phone:409-351-0498
Mailing Address - Fax:
Practice Address - Street 1:6630 DE MOSS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-5004
Practice Address - Country:US
Practice Address - Phone:713-634-1069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83019133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered