Healthcare Provider Details

I. General information

NPI: 1063306579
Provider Name (Legal Business Name): COREY HOBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2025
Last Update Date: 06/07/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4381 E LARIAT LN
PHOENIX AZ
85050-8903
US

IV. Provider business mailing address

4381 E LARIAT LN
PHOENIX AZ
85050-8903
US

V. Phone/Fax

Practice location:
  • Phone: 714-402-5625
  • Fax:
Mailing address:
  • Phone: 714-402-5625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86293758
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: