MEDICARE: CARIE PERRINO NMD, RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath	22-1748	AZ
2	133V00000X	Registered Dietitian	164006255	IL

General Provider Information

NPI Number	:	1073913737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARIE PERRINO NMD, RDN

Provider Business Mailing Address
First Line	:	123 E BASELINE RD STE D208
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-1298
Country	:	US
Telephone Number	:	480-914-0521
Fax Number	:	480-914-0522

Provider Business Practice Location Address
First Line	:	123 E BASELINE RD STE D208
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-1298
Country	:	US
Telephone Number	:	480-914-0521
Fax Number	:	480-914-0522

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2014
Last Update Date	:	02/27/2024

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