Provider Demographics
NPI:1922641034
Name:BOBZIEN, MALLORY PATRICIA
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:PATRICIA
Last Name:BOBZIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 LAKE POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-8410
Mailing Address - Country:US
Mailing Address - Phone:214-695-1157
Mailing Address - Fax:
Practice Address - Street 1:9301 N CENTRAL EXPY STE 685
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0816
Practice Address - Country:US
Practice Address - Phone:214-389-9130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered