Provider Demographics
NPI:1306263975
Name:SIA, DEHORNE (RD)
Entity type:Individual
Prefix:MR
First Name:DEHORNE
Middle Name:
Last Name:SIA
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 CORPORATE DR
Mailing Address - Street 2:STE # 120
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-5139
Mailing Address - Country:US
Mailing Address - Phone:713-773-0803
Mailing Address - Fax:713-271-5422
Practice Address - Street 1:7001 CORPORATE DR
Practice Address - Street 2:STE. 120
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-5139
Practice Address - Country:US
Practice Address - Phone:713-773-0803
Practice Address - Fax:713-271-5422
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82704133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT82704OtherTX STATE BOARD LISCENSE