Provider Demographics
NPI:1386289627
Name:NOROOZIAN, MUJAN (RD)
Entity type:Individual
Prefix:
First Name:MUJAN
Middle Name:
Last Name:NOROOZIAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18450 HIGHWAY 59 N
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4404
Mailing Address - Country:US
Mailing Address - Phone:281-446-6656
Mailing Address - Fax:281-446-6657
Practice Address - Street 1:18450 HIGHWAY 59 N
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4404
Practice Address - Country:US
Practice Address - Phone:281-446-6656
Practice Address - Fax:281-446-6657
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84008133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX404977701Medicaid
TX883224OtherMEDICARE
TX8MB030OtherBCBS