Basic Information
| Provider Information | |||||||||
| NPI: | 1750492229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOLAND | ||||||||
| FirstName: | TRINA | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | DIETITIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1302 N SHEPHERD DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770083752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136963131 | ||||||||
| FaxNumber: | 7136962133 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 W LITTLE YORK RD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770761303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136963131 | ||||||||
| FaxNumber: | 7136962133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 10/26/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | DT05574 | TX | Y | Dietary & Nutritional Service Providers | Nutritionist |
No ID Information.