Provider Demographics
NPI:1104119643
Name:HARIPRASAD, NAVIN (RD/LD)
Entity type:Individual
Prefix:
First Name:NAVIN
Middle Name:
Last Name:HARIPRASAD
Suffix:
Gender:M
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 COMMERCE ST
Mailing Address - Street 2:517
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-4917
Mailing Address - Country:US
Mailing Address - Phone:972-839-5643
Mailing Address - Fax:
Practice Address - Street 1:1512 COMMERCE ST
Practice Address - Street 2:517
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-4917
Practice Address - Country:US
Practice Address - Phone:972-839-5643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81846133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered