Healthcare Provider Details

I. General information

NPI: 1447076146
Provider Name (Legal Business Name): TRACI GRGICH MS, RD, SNS, CP-FS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E ERIE ST
GILBERT AZ
85295-5528
US

IV. Provider business mailing address

1510 E ERIE ST
GILBERT AZ
85295-5528
US

V. Phone/Fax

Practice location:
  • Phone: 480-966-2741
  • Fax:
Mailing address:
  • Phone: 480-966-2741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: