Healthcare Provider Details

I. General information

NPI: 1467319889
Provider Name (Legal Business Name): WILLIAM BOZEMAN DHSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 E BASELINE RD STE 101
MESA AZ
85206-4413
US

IV. Provider business mailing address

4140 E BASELINE RD STE 101
MESA AZ
85206-4413
US

V. Phone/Fax

Practice location:
  • Phone: 505-870-4949
  • Fax: 877-285-0477
Mailing address:
  • Phone: 505-870-4949
  • Fax: 877-285-0477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: