Healthcare Provider Details

I. General information

NPI: 1295332187
Provider Name (Legal Business Name): MATTHE D ESSEX MS, CN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10165 N 92ND ST STE 103
SCOTTSDALE AZ
85258-4558
US

IV. Provider business mailing address

3370 N HAYDEN RD # 123-505
SCOTTSDALE AZ
85251-6632
US

V. Phone/Fax

Practice location:
  • Phone: 480-304-5656
  • Fax:
Mailing address:
  • Phone: 602-741-6739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: