Organization
DIABETIC NUTRITIONAL EDUCATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN ELLIS D.O (CHIEF MEDICAL DIRECTOR)
(623) 277-2246
Entity
Organization
Contact information
Practice address
25500 N NORTERRA DR, ATTN: HCFS, PHOENIX, AZ 85085-8200
(602) 328-8400
Mailing address
25500 N NORTERRA DR, ATTN: HCFS, PHOENIX, AZ 85085-8200
(602) 328-8400
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
Other
Enumeration date
08/31/2006
Last updated
01/28/2014
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