Demetrius Jermaine Willis, MBA, MS, RD, LD, CPT
Dietitian, Registered in San Antonio, TX. Individual provider (NPI-1).
NPI number1508098567
StatusActive
Last updated in NPPESAug 10, 2009
Details
- NPI
- 1508098567
- Entity type
- Individual (NPI-1)
- Name
- Mr. Demetrius Jermaine Willis
- Credential
- MBA, MS, RD, LD, CPT
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Aug 10, 2009
- Last updated
- Aug 10, 2009
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 133V00000X | Dietitian, Registered | DT81138 | TX | Yes |
Practice location
225 E Sonterra BlvdSan Antonio, TX 78258-3992
Phone 210-477-2799
Mailing address
6422 Merlin WaySan Antonio, TX 78233-4661
Phone 121-048-5841
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