Provider Demographics
NPI:1104247790
Name:ENRIQUEZ, VANESSA (RD, LD, CDE)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 COIT RD
Mailing Address - Street 2:STE 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-5024
Mailing Address - Country:US
Mailing Address - Phone:469-467-9499
Mailing Address - Fax:469-467-7009
Practice Address - Street 1:1708 COIT RD
Practice Address - Street 2:STE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-5024
Practice Address - Country:US
Practice Address - Phone:469-467-9499
Practice Address - Fax:469-467-7009
Is Sole Proprietor?:No
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81917133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered