Provider Demographics
NPI:1871680702
Name:BHALLA, VIJAY S (PHD,RD,LDN)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:S
Last Name:BHALLA
Suffix:
Gender:F
Credentials:PHD,RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 HIXON DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3306
Mailing Address - Country:US
Mailing Address - Phone:505-523-1146
Mailing Address - Fax:
Practice Address - Street 1:2025 HIXON DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3306
Practice Address - Country:US
Practice Address - Phone:505-523-1146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered