Provider Demographics
NPI:1942662283
Name:UP4 NUTRITION LLC
Entity Type:Organization
Organization Name:UP4 NUTRITION LLC
Other - Org Name:UP4 NUTRITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:UZMA
Authorized Official - Middle Name:WAHEED
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD LD
Authorized Official - Phone:469-471-1988
Mailing Address - Street 1:4405 BOULDER DRIVE
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:TX
Mailing Address - Zip Code:75002
Mailing Address - Country:US
Mailing Address - Phone:469-471-1988
Mailing Address - Fax:
Practice Address - Street 1:3417 SPECTRUM BLVD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-9705
Practice Address - Country:US
Practice Address - Phone:469-471-1988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
TXDT07722305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty