Individual
MR. CHARLES HIGGINS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RD CSR
Contact information
Practice address
1601 E HIGHLAND AVE APT 1082, PHOENIX, AZ 85016-0609
(716) 425-2764
(602) 840-4445
Mailing address
1601 E HIGHLAND AVE APT 1082, PHOENIX, AZ 85016-0609
(716) 425-2764
(602) 840-4445
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
1081333
AZ
133VN1005X
Renal Nutrition Registered Dietitian
Primary
1081333
AZ
133VN1005X
Renal Nutrition Registered Dietitian
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1081333
RD CSR
AZ
Enumeration date
09/22/2017
Last updated
04/12/2021
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