Dorian Venable II
Individual provider Active NPI Registered Dietitian · Tsaile, AZ
NPI 1902148646 · NPPES record last updated Mar 9, 2017
Key facts
- NPI
- 1902148646
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- DT07319 (TX)
- Practice address
- Navajo Route 64
Tsaile, AZ 86556 - Phone
- (928) 724-3612
- Fax
- (928) 724-3671
- NPI assigned
- Mar 20, 2013
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181227000330 | TX | Practitioner - Registered Dietitian Or Nutrition Professional | 9335484062 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DHHS PHS Naihs Chinle Comprehensive Health Care Facility | Current | Accepting new patients | |
| DHHS PHS Naihs Chinle Comprehensive Health Care Facility | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DT07319 | TX | Yes |
Addresses
Primary practice location
Navajo Route 64
Tsaile, AZ 86556
Mailing address
PO Box PH
Chinle, AZ 86503-8000
Phone (928) 674-7166
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 933052 | Other | CDR |
Other providers in Tsaile, AZ
- Nathalie Renee Seoldo
- Terry Lee Teller
- Gregory Alan Thompson
- Tsaile Health Center Pharmacy
- Tsin-Nan-Tee, Elderly Care Provider, LLC
- Michael John Yager
All providers in Tsaile, AZ · Registered Dietitian in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.