Provider Demographics
NPI:1992061220
Name:ESTRADA, RUTH (RD, LD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:ESTRADA
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:PO BOX 3664
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77253-3664
Mailing Address - Country:US
Mailing Address - Phone:832-563-2197
Mailing Address - Fax:
Practice Address - Street 1:23920 KATY FWY
Practice Address - Street 2:SUITE 310
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1341
Practice Address - Country:US
Practice Address - Phone:281-392-8920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82343133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered