Provider Demographics
NPI:1336561695
Name:AZZI, MADELEINA
Entity Type:Individual
Prefix:
First Name:MADELEINA
Middle Name:
Last Name:AZZI
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 1:20603 CHAPEL GLEN CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-6642
Mailing Address - Country:US
Mailing Address - Phone:832-830-1839
Mailing Address - Fax:
Practice Address - Street 1:801 TOWN AND COUNTRY LN # 319
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2238
Practice Address - Country:US
Practice Address - Phone:832-830-1839
Practice Address - Fax:713-486-5622
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81354133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered