Healthcare Provider Details

I. General information

NPI: 1437385416
Provider Name (Legal Business Name): DIABETES AND HEART HEALTH CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20100 N 51ST AVE SUITE #F640
GLENDALE AZ
85308-5125
US

IV. Provider business mailing address

5420 W MURIEL DR
GLENDALE AZ
85308-5380
US

V. Phone/Fax

Practice location:
  • Phone: 623-521-5867
  • Fax: 602-441-3934
Mailing address:
  • Phone: 623-521-5867
  • Fax: 602-441-3934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License NumberS011205
License Number StateAZ

VIII. Authorized Official

Name: DR. NIRALI SONI
Title or Position: DIABETES PROGRAM MANAGER
Credential: PHARM.D, RPH, CDE
Phone: 623-521-5867