Healthcare Provider Details

I. General information

NPI: 1356181408
Provider Name (Legal Business Name): EMILY ORVOS MS, RD, CSSD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 W ELM ST
PHOENIX AZ
85013-2456
US

IV. Provider business mailing address

740 W ELM ST UNIT 106
PHOENIX AZ
85013-2457
US

V. Phone/Fax

Practice location:
  • Phone: 816-590-9812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number086099938
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number086099938
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: