Organization
GLENDALE REDBIRD CO
Active
Organization
GLENDALE REDBIRD CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MYDUNG THI PHAN (CFO)
(623) 624-5207
Entity
Organization
Contact information
Practice address
6637 N 58TH DR APT 7, GLENDALE, AZ 85301-3900
(623) 624-5179
Mailing address
6637 N 58TH DR APT 3, GLENDALE, AZ 85301-3900
(623) 624-5207
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
175T00000X
Peer Specialist
—
—
305S00000X
Point of Service
—
—
347C00000X
Private Vehicle
—
—
347E00000X
Transportation Broker
—
—
Other
Enumeration date
09/04/2024
Last updated
11/12/2024
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