Provider Demographics
NPI:1932824315
Name:WIRTZ, CHRISTINA (RDN)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:WIRTZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 KINGS RD APT 3117
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-7423
Mailing Address - Country:US
Mailing Address - Phone:972-679-1068
Mailing Address - Fax:
Practice Address - Street 1:1621 N BELT LINE RD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-1794
Practice Address - Country:US
Practice Address - Phone:972-682-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT88088133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86289951OtherCDR (COMMISSION ON DIETETIC REGISTRATION)