Healthcare Provider Details

I. General information

NPI: 1871083584
Provider Name (Legal Business Name): SARAH KISER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date: 12/11/2019
Reactivation Date: 12/03/2025

III. Provider practice location address

10864 N AVENIDA VALLEJO
TUCSON AZ
85737-6895
US

IV. Provider business mailing address

10864 N AVENIDA VALLEJO
TUCSON AZ
85737-6895
US

V. Phone/Fax

Practice location:
  • Phone: 954-643-9166
  • Fax:
Mailing address:
  • Phone: 954-643-9166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1060157
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: