Healthcare Provider Details

I. General information

NPI: 1750786380
Provider Name (Legal Business Name): CLAUDIA VAZ DE LIMA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 12/12/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 N TATUM BLVD STE 102
PHOENIX AZ
85028-6056
US

IV. Provider business mailing address

10810 N TATUM BLVD STE 102
PHOENIX AZ
85028-6056
US

V. Phone/Fax

Practice location:
  • Phone: 201-555-0123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86004493
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: