Healthcare Provider Details

I. General information

NPI: 1851644918
Provider Name (Legal Business Name): NUTRITIONAL SERVICES OF SOUTHERN ARIZONA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N KOLB RD
TUCSON AZ
85710-1333
US

IV. Provider business mailing address

850 N KOLB RD
TUCSON AZ
85710-1333
US

V. Phone/Fax

Practice location:
  • Phone: 520-954-2551
  • Fax: 520-393-3326
Mailing address:
  • Phone: 520-954-2551
  • Fax: 520-393-3326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MARY J PICCHIONI
Title or Position: OWNER AND PRESIDENT
Credential: PH.D.
Phone: 520-954-2551