Healthcare Provider Details

I. General information

NPI: 1912446113
Provider Name (Legal Business Name): RADIX NUTRITION & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3738 E WELDON AVE
PHOENIX AZ
85018-5816
US

IV. Provider business mailing address

3738 E WELDON AVE
PHOENIX AZ
85018-5816
US

V. Phone/Fax

Practice location:
  • Phone: 720-517-4683
  • Fax:
Mailing address:
  • Phone: 720-517-4683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: DEBRA BRUNK
Title or Position: OWNER, NUTRITIONIST
Credential: MS, PHD
Phone: 720-517-4683