MEDICARE: ARIAH FISH MS, RD, ISAK I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1501X	Sports Dietetics Nutrition Registered Dietitian

General Provider Information

NPI Number	:	1376385799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIAH FISH MS, RD, ISAK I

Provider Business Mailing Address
First Line	:	1717 W HAPPY VALLEY RD UNIT 1061
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-0021
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 W HAPPY VALLEY RD UNIT 1061
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-0021
Country	:	US
Telephone Number	:	610-220-2645
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2024
Last Update Date	:	06/07/2024

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