Provider Demographics
NPI:1366760423
Name:W.I.S.H. 'WEIGHT INITIATIVE TO SUSTAIN HEALTH'
Entity type:Organization
Organization Name:W.I.S.H. 'WEIGHT INITIATIVE TO SUSTAIN HEALTH'
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:BRAVO
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:956-221-2465
Mailing Address - Street 1:520 E REDBUD AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 E REDBUD AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2468
Practice Address - Country:US
Practice Address - Phone:956-221-2465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81521133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty