Provider Demographics
NPI:1902228646
Name:NUTRILICIOUSBYZ
Entity Type:Organization
Organization Name:NUTRILICIOUSBYZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:ZARANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAREKH
Authorized Official - Suffix:
Authorized Official - Credentials:RDN,LD
Authorized Official - Phone:214-914-3778
Mailing Address - Street 1:1400 VALLEY TRL
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5071
Mailing Address - Country:US
Mailing Address - Phone:214-914-3778
Mailing Address - Fax:
Practice Address - Street 1:1400 VALLEY TRL
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-5071
Practice Address - Country:US
Practice Address - Phone:214-914-3778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80225133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Multi-Specialty