Provider Demographics
NPI:1538621230
Name:CHEN, CONNIE MARIA (RDLD)
Entity type:Individual
Prefix:MISS
First Name:CONNIE
Middle Name:MARIA
Last Name:CHEN
Suffix:
Gender:F
Credentials:RDLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 BURKE RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-3451
Mailing Address - Country:US
Mailing Address - Phone:713-894-5323
Mailing Address - Fax:
Practice Address - Street 1:4002 BURKE RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-3451
Practice Address - Country:US
Practice Address - Phone:713-894-5323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT95841133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered