Healthcare Provider Details

I. General information

NPI: 1174677355
Provider Name (Legal Business Name): AKEMI S GLASS R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AKEMI SATO R.D.

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CAMPBELL DR
TORRINGTON WY
82240-1528
US

IV. Provider business mailing address

1010 N COUNTRY CLUB DR
MESA AZ
85201-3309
US

V. Phone/Fax

Practice location:
  • Phone: 307-532-4181
  • Fax:
Mailing address:
  • Phone: 480-461-2409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number841164
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: