Provider Demographics
NPI:1720720824
Name:POPP, BRUNA BARROS (RD)
Entity Type:Individual
Prefix:MRS
First Name:BRUNA
Middle Name:BARROS
Last Name:POPP
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 E 135TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-1030
Mailing Address - Country:US
Mailing Address - Phone:954-495-0615
Mailing Address - Fax:
Practice Address - Street 1:2020 E 135TH ST S
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-1030
Practice Address - Country:US
Practice Address - Phone:954-495-0615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-09
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLD2063133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered