Provider Demographics
NPI:1891279170
Name:BARAJAS, REBECCA (RDN, LD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BARAJAS
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 SHORT LINE BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-6728
Mailing Address - Country:US
Mailing Address - Phone:318-550-7714
Mailing Address - Fax:
Practice Address - Street 1:2400 N I 35
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5240
Practice Address - Country:US
Practice Address - Phone:469-843-4141
Practice Address - Fax:469-843-4140
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83945133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered