Active NPI
Selena Diaz
- Registered Dietitian
- Burleson, TX
National Provider Identifier
1063157766
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 11801 South Fwy
Burleson, TX 76028-7021 - Phone
- (817) 551-2706
- NPI assigned
- Apr 28, 2022
- Last updated
- Jun 13, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | Primary |
Addresses
Primary practice location
11801 South Fwy
Burleson, TX 76028-7021
Mailing address
11801 S. Freeway
Fort Worth, TX 76115
Phone (817) 551-2706
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1651104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655078400000",
"number": "1063157766",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11801 S. FREEWAY",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "76115",
"telephone_number": "817-551-2706"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11801 SOUTH FWY",
"city": "BURLESON",
"state": "TX",
"postal_code": "760287021",
"telephone_number": "817-551-2706"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAZ",
"first_name": "SELENA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-04-28",
"last_updated": "2022-06-13",
"certification_date": "2022-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burleson, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.