Healthcare Provider Details

I. General information

NPI: 1598257248
Provider Name (Legal Business Name): CORINNE C CIURIS R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 E CAMBRIDGE AVE STE 301
PHOENIX AZ
85006-1464
US

IV. Provider business mailing address

2108 E THOMAS RD STE 130
PHOENIX AZ
85016-7761
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-0935
  • Fax: 602-933-2471
Mailing address:
  • Phone: 602-933-1813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86099603
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: