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General NPI Number Information
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NPI Number | 1023844479
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Entity Type | Individual
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Provider Name | RON ALLEN FENTON RDN
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Gender | Male
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Dates
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Enumeration Date | 09/11/2024
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 13395 N MARANA MAIN ST
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City | MARANA
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State | AZ
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Zip | 85653-7008
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Country | US
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Telephone | 520-682-4111
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Fax |
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Provider Business Mailing Address
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Address Line | 8401 S KOLB RD UNIT 172
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City | TUCSON
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State | AZ
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Zip | 85756-9617
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Country | US
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Telephone | 559-321-4648
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 810439
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License Number State | TX
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