Provider Demographics
NPI:1063872513
Name:RX NUTRITION PROFESSIONALS
Entity type:Organization
Organization Name:RX NUTRITION PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BZDOK
Authorized Official - Suffix:
Authorized Official - Credentials:RD,CSR,LD
Authorized Official - Phone:512-809-3689
Mailing Address - Street 1:2713 BLAKE ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-3951
Mailing Address - Country:US
Mailing Address - Phone:512-809-3689
Mailing Address - Fax:512-852-6691
Practice Address - Street 1:7500 RIALTO BLVD STE 250
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8556
Practice Address - Country:US
Practice Address - Phone:512-809-3689
Practice Address - Fax:512-852-6691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81976133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty