Healthcare Provider Details

I. General information

NPI: 1891232351
Provider Name (Legal Business Name): ELVIA MADRID RDN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1746 W GLENROSA AVE
PHOENIX AZ
85015-4736
US

IV. Provider business mailing address

1746 W GLENROSA AVE
PHOENIX AZ
85015-4736
US

V. Phone/Fax

Practice location:
  • Phone: 602-616-1685
  • Fax:
Mailing address:
  • Phone: 602-616-1685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86049899
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: