Provider Demographics
NPI:1487759601
Name:SANCHEZ, GRACIELA HERNANDEZ (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:GRACIELA
Middle Name:HERNANDEZ
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MS
Other - First Name:GRACIE
Other - Middle Name:H
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN, LDN
Mailing Address - Street 1:11625 CUSTER RD STE 110504
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-8783
Mailing Address - Country:US
Mailing Address - Phone:214-945-3757
Mailing Address - Fax:888-373-1936
Practice Address - Street 1:11625 CUSTER RD # 110-504
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-8783
Practice Address - Country:US
Practice Address - Phone:214-945-3757
Practice Address - Fax:888-373-1936
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07655133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1871824-02Medicaid