Provider Demographics
NPI:1962157594
Name:VERGHESE, ANILA RACHEL (RD, LD)
Entity type:Individual
Prefix:
First Name:ANILA
Middle Name:RACHEL
Last Name:VERGHESE
Suffix:
Gender:F
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 1:20811 PINEBROOK HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-8218
Mailing Address - Country:US
Mailing Address - Phone:713-969-9656
Mailing Address - Fax:
Practice Address - Street 1:20811 PINEBROOK HOLLOW LN
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-8218
Practice Address - Country:US
Practice Address - Phone:713-969-9656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT85497OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION