Healthcare Provider Details

I. General information

NPI: 1154128221
Provider Name (Legal Business Name): FIM HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N CENTRAL AVE FL 1
PHOENIX AZ
85004-2309
US

IV. Provider business mailing address

112 N CENTRAL AVE FL 1
PHOENIX AZ
85004-2309
US

V. Phone/Fax

Practice location:
  • Phone: 480-382-2139
  • Fax:
Mailing address:
  • Phone: 480-382-2139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: GUANLAN LIU
Title or Position: CEO/OWNER
Credential: RD
Phone: 480-639-9327