Provider Demographics
NPI:1174360275
Name:PARVIS, ANDREA MORENO (MS ,RD, CSPCC, LD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MORENO
Last Name:PARVIS
Suffix:
Gender:F
Credentials:MS ,RD, CSPCC, LD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:DIANE
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8811 WENONA WALK
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8811 WENONA WALK
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-6155
Practice Address - Country:US
Practice Address - Phone:832-723-4897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered