MEDICARE: AMARIS FENO R.D.

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	133V00000X	Registered Dietitian	86000525

General Provider Information

NPI Number	:	1164850343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMARIS FENO R.D.

Provider Business Mailing Address
First Line	:	7349 N VIA PASEO DEL SUR STE 515
Second Line	:	PMB 91
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-3764
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8323 E VIA DE DORADO
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-3805
Country	:	US
Telephone Number	:	602-616-4259
Fax Number	:

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

Provider Enumeration Date	:	10/24/2013
Last Update Date	:	10/24/2013

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