Provider Demographics
NPI:1932796968
Name:JACOB, MEREEN (RDN, LD)
Entity Type:Individual
Prefix:
First Name:MEREEN
Middle Name:
Last Name:JACOB
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 1:6611 MISTY CRK
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3191
Mailing Address - Country:US
Mailing Address - Phone:281-451-2478
Mailing Address - Fax:
Practice Address - Street 1:6611 MISTY CRK
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3191
Practice Address - Country:US
Practice Address - Phone:281-451-2478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86819133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered