Healthcare Provider Details

I. General information

NPI: 1851767750
Provider Name (Legal Business Name): DELIA SALAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3213 N ASH CIR
CHANDLER AZ
85224-1277
US

IV. Provider business mailing address

3213 N ASH CIR
CHANDLER AZ
85224-1277
US

V. Phone/Fax

Practice location:
  • Phone: 480-452-3612
  • Fax:
Mailing address:
  • Phone: 480-452-3612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number133N00000X
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: