Healthcare Provider Details

I. General information

NPI: 1477875409
Provider Name (Legal Business Name): RACHEL HEAD RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

1919 E THOMAS RD BLDG 2108, SUITE 101
PHOENIX AZ
85016-7710
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-0935
  • Fax: 602-933-0610
Mailing address:
  • Phone: 602-512-8029
  • Fax: 602-512-8161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT81293
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number996348
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: