Healthcare Provider Details

I. General information

NPI: 1982895231
Provider Name (Legal Business Name): CYNTHIA S. THOMAS M.S., R.D., C.D.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 05/14/2008
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

11001 N BLACK CANYON HWY
PHOENIX AZ
85029-4757
US

V. Phone/Fax

Practice location:
  • Phone: 602-271-5111
  • Fax:
Mailing address:
  • Phone: 602-942-4462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number717471
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: