Provider Demographics
NPI:1801034871
Name:TAPIA, ANGELICA G (RD, LD)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:G
Last Name:TAPIA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 S. ERVAY ST
Mailing Address - Street 2:THIRD FLOOR ROOM 307
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-6420
Mailing Address - Country:US
Mailing Address - Phone:972-794-4569
Mailing Address - Fax:972-794-4573
Practice Address - Street 1:1250 8TH AVE STE 135
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4156
Practice Address - Country:US
Practice Address - Phone:817-923-8050
Practice Address - Fax:817-920-0562
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT080472133VN1005X
TXDT80472133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT080472OtherMEDICAL LICENSE