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General NPI Number Information
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NPI Number | 1639473143
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Entity Type | Individual
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Provider Name | DAMIAN PLUES RD, CDE
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Gender | Male
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Dates
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Enumeration Date | 12/28/2010
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Last Update Date | 12/28/2010
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Provider Practice Location Address
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Address Line | 483 W. SEED FARM ROAD
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City | SACATON
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State | AZ
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Zip | 85147
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Country | US
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Telephone | 602-271-7940
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Fax |
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Provider Business Mailing Address
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Address Line | 15963 W YAVAPAI ST
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City | GOODYEAR
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State | AZ
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Zip | 85338-9496
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Country | US
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Telephone | 623-217-6576
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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 | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 2011-0505
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 964240
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License Number State | AZ
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