Healthcare Provider Details

I. General information

NPI: 1538778923
Provider Name (Legal Business Name): CYNTHIA SANCHEZ NDTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4925 W SANDRA TER
GLENDALE AZ
85306-2035
US

IV. Provider business mailing address

4925 W SANDRA TER
GLENDALE AZ
85306-2035
US

V. Phone/Fax

Practice location:
  • Phone: 623-340-8994
  • Fax:
Mailing address:
  • Phone: 623-340-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: