Healthcare Provider Details

I. General information

NPI: 1518318922
Provider Name (Legal Business Name): NEWMARK NUTRITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E EARLL DR STE 425
PHOENIX AZ
85012-2649
US

IV. Provider business mailing address

5182 W VISTA AVE
GLENDALE AZ
85301-8610
US

V. Phone/Fax

Practice location:
  • Phone: 602-264-3587
  • Fax:
Mailing address:
  • Phone: 602-264-3587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: JAYNE NEWMARK
Title or Position: OWNER
Credential: RD
Phone: 602-264-3587