MEDICARE: DIABETES DIMENSIONS, LLC

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	877907	AZ

General Provider Information

NPI Number	:	1245275965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETES DIMENSIONS, LLC

Provider Business Mailing Address
First Line	:	73885 GUN CIR
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-1524
Country	:	US
Telephone Number	:	928-412-1433
Fax Number	:	928-733-2415

Provider Business Practice Location Address
First Line	:	73885 GUN CIR
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-1524
Country	:	US
Telephone Number	:	928-412-1433
Fax Number	:	928-733-2415

Authorized Official
Title or Position	:	SOLE PROVIDER
Name	:	MS. SHERRI A MASON
Credential	:	RD, CDE
Telephone Number	:	928-412-1433

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	07/25/2019

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