Organization
AZ DIETITIANS LLC
Active
Other names
AZ Dietitians
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERRY KAY JOHNSON (CREDENTIALING SPECIALIST)
(480) 920-4442
Entity
Organization
Contact information
Practice address
6124 E BROWN RD STE 102, MESA, AZ 85205-4959
(480) 809-6513
Mailing address
6124 E BROWN RD STE 102, MESA, AZ 85205-4959
(480) 809-6513
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86063644
AZ
Other
Enumeration date
05/08/2018
Last updated
07/31/2018
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