Provider Demographics
NPI:1922661495
Name:MASLOVITZ, AVIS GRAFF (RDN,LD)
Entity Type:Individual
Prefix:
First Name:AVIS
Middle Name:GRAFF
Last Name:MASLOVITZ
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 1:219 N LOOP 336 E UNIT 5104
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-1541
Mailing Address - Country:US
Mailing Address - Phone:936-446-9161
Mailing Address - Fax:
Practice Address - Street 1:219 N LOOP 336 E UNIT 5104
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1541
Practice Address - Country:US
Practice Address - Phone:936-446-9161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT00175133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty