Healthcare Provider Details

I. General information

NPI: 1548064538
Provider Name (Legal Business Name): ELENA COLOMBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2162 E WILLIAMS FIELD RD STE SUITE111
GILBERT AZ
85295-0735
US

IV. Provider business mailing address

PO BOX 1618
GILBERT AZ
85299-1618
US

V. Phone/Fax

Practice location:
  • Phone: 602-919-2852
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: