Provider Demographics
NPI:1750492229
Name:BOLAND, TRINA I (DIETITIAN)
Entity Type:Individual
Prefix:MISS
First Name:TRINA
Middle Name:I
Last Name:BOLAND
Suffix:
Gender:F
Credentials:DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 N SHEPHERD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-3752
Mailing Address - Country:US
Mailing Address - Phone:713-696-3131
Mailing Address - Fax:713-696-2133
Practice Address - Street 1:300 W LITTLE YORK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-1303
Practice Address - Country:US
Practice Address - Phone:713-696-3131
Practice Address - Fax:713-696-2133
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05574133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist