Healthcare Provider Details

I. General information

NPI: 1578349056
Provider Name (Legal Business Name): ANGELA MARIA SZCZERBIAK RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA MARIA SZCZERBIAK RD

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5546 W ROOSEVELT ST STE 1
PHOENIX AZ
85043-2608
US

IV. Provider business mailing address

5546 W ROOSEVELT ST STE 1
PHOENIX AZ
85043-2608
US

V. Phone/Fax

Practice location:
  • Phone: 602-352-0724
  • Fax:
Mailing address:
  • Phone: 602-352-0724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number164.007817
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: