Healthcare Provider Details

I. General information

NPI: 1801305669
Provider Name (Legal Business Name): LAUREN KATE PELLIZZON MS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 09/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 N HIGLEY RD STE 306
GILBERT AZ
85234-1625
US

IV. Provider business mailing address

8021 E OSBORN RD
SCOTTSDALE AZ
85251-4876
US

V. Phone/Fax

Practice location:
  • Phone: 480-543-2606
  • Fax:
Mailing address:
  • Phone: 909-438-5988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86061678
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: