Healthcare Provider Details

I. General information

NPI: 1093397721
Provider Name (Legal Business Name): MARY CURTIS HNC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 N COUNTRY CLUB DR
PHOENIX AZ
85014-5443
US

IV. Provider business mailing address

8100 PASEO DEL OCASO STE D
LA JOLLA CA
92037-3115
US

V. Phone/Fax

Practice location:
  • Phone: 602-882-7788
  • Fax:
Mailing address:
  • Phone: 602-882-7788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number10649
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: