Provider Demographics
NPI:1063213130
Name:GREEN, HILDA (RDLD)
Entity type:Individual
Prefix:
First Name:HILDA
Middle Name:
Last Name:GREEN
Suffix:
Gender:
Credentials:RDLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 N STATE HIGHWAY 360 APT 519
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-1078
Mailing Address - Country:US
Mailing Address - Phone:214-668-0449
Mailing Address - Fax:
Practice Address - Street 1:17350 STATE HIGHWAY 249 STE 220
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-1132
Practice Address - Country:US
Practice Address - Phone:469-279-8591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81493133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered