Healthcare Provider Details

I. General information

NPI: 1912660739
Provider Name (Legal Business Name): RIGO RAMOS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W KRISTAL WAY
PHOENIX AZ
85027-5219
US

IV. Provider business mailing address

2501 W. HAPPY VALLEY RD. 1027 STE. 4
PHOENIX AZ
85085
US

V. Phone/Fax

Practice location:
  • Phone: 480-634-3637
  • Fax:
Mailing address:
  • Phone: 480-634-3637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: