Healthcare Provider Details

I. General information

NPI: 1689312944
Provider Name (Legal Business Name): MASON ZUNIGA RDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 S SHIELA AVE
TUCSON AZ
85735-9345
US

IV. Provider business mailing address

2850 S SHIELA AVE
TUCSON AZ
85735-9345
US

V. Phone/Fax

Practice location:
  • Phone: 520-395-7838
  • Fax:
Mailing address:
  • Phone: 520-395-7838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86151459
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: