Provider Demographics
NPI:1487434304
Name:GOMEZ, DAHLIA (MS, RD, CDCES)
Entity type:Individual
Prefix:
First Name:DAHLIA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MS, RD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11743 WAYWARD DAISY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-2470
Mailing Address - Country:US
Mailing Address - Phone:432-940-0786
Mailing Address - Fax:
Practice Address - Street 1:11743 WAYWARD DAISY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-2470
Practice Address - Country:US
Practice Address - Phone:432-940-0786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83761133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered