Provider Demographics
NPI:1821543497
Name:BIODEZYNE CENTER OF VICTORIA
Entity Type:Organization
Organization Name:BIODEZYNE CENTER OF VICTORIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:N
Authorized Official - Last Name:JARRETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:361-573-4711
Mailing Address - Street 1:4206 N BEN JORDAN ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3076
Mailing Address - Country:US
Mailing Address - Phone:361-573-4711
Mailing Address - Fax:361-573-4065
Practice Address - Street 1:4206 N BEN JORDAN ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3076
Practice Address - Country:US
Practice Address - Phone:361-573-4711
Practice Address - Fax:361-573-4065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty