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General NPI Number Information
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NPI Number | 1013472158
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Entity Type | Organization
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Legal Business Name | SOUTHERN AZ NUTRITION CONSULTANTS, LLC
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Dates
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Enumeration Date | 02/03/2019
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 1100 E AJO WAY STE 212
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City | TUCSON
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State | AZ
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Zip | 85713-5055
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Country | US
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Telephone | 520-904-0889
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Fax |
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Provider Business Mailing Address
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Address Line | 11414 E SQUASH BLOSSOM LOOP
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City | TUCSON
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State | AZ
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Zip | 85747-6219
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Country | US
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Telephone | 520-904-0889
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Fax |
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Authorized Official
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Title or Position | OWNER, OPERATOR
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Name | JAVIER GOMEZ
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Credential | RDN, CDE
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Telephone | 520-904-0889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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