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General NPI Number Information
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NPI Number | 1881470433
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Entity Type | Organization
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Legal Business Name | COMPLETE MEDICAL NUTRITION THERAPY LLC
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Dates
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Enumeration Date | 09/07/2023
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 6432 S 47TH ST
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City | PHOENIX
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State | AZ
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Zip | 85042-5349
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Country | US
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Telephone | 602-410-3694
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Fax |
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Provider Business Mailing Address
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Address Line | 3104 E CAMELBACK RD UNIT 7615
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City | PHOENIX
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State | AZ
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Zip | 85016-4502
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Country | US
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Telephone | 602-410-3694
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ZULEMA ARYSSA JACKMAN
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Credential |
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Telephone | 602-410-3694
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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 |
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License Number State |
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