Healthcare Provider Details

I. General information

NPI: 1033446711
Provider Name (Legal Business Name): MARIBEL PASTRAN RD, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIBEL HIDALGO RD, CD

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CORNER OF ROUTE N12 AND N7
FORT DEFIANCE AZ
86504-0649
US

IV. Provider business mailing address

PO BOX 649
FORT DEFIANCE AZ
86504-0649
US

V. Phone/Fax

Practice location:
  • Phone: 928-729-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1265
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number819840
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD007241
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: