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General NPI Number Information
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NPI Number | 1407243686
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Entity Type | Individual
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Provider Name | KIMBERLY SPEROS RD CNSC
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Gender | Female
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Dates
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Enumeration Date | 04/24/2015
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Last Update Date | 04/24/2015
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Provider Practice Location Address
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Address Line | 350 W THOMAS RD FOOD & NUTRITION DEPARTMENT
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City | PHOENIX
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State | AZ
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Zip | 85013-4409
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Country | US
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Telephone | 602-406-3115
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Fax | 602-406-6660
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Provider Business Mailing Address
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Address Line | 1210 E NORTHERN AVE
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City | PHOENIX
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State | AZ
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Zip | 85020-4217
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Country | US
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Telephone | 602-677-4164
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Fax | 602-532-7146
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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 | 11002
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License Number State | CA
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