Individual
CARISSA GORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
1666 S DOBSON RD APT 4062, MESA, AZ 85202-1614
(623) 512-9626
Mailing address
7130 W TETHER TRL, PEORIA, AZ 85383-7340
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
—
—
Other
Enumeration date
12/03/2025
Last updated
12/03/2025
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