Healthcare Provider Details

I. General information

NPI: 1831691864
Provider Name (Legal Business Name): ANDREW JAMES MS, RD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 E MCDOWELL RD
PHOENIX AZ
85006-2506
US

IV. Provider business mailing address

2959 E LARKSPUR DR
PHOENIX AZ
85032-7123
US

V. Phone/Fax

Practice location:
  • Phone: 602-521-3090
  • Fax:
Mailing address:
  • Phone: 602-769-1815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86012651
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: