MEDICARE: ZULEMA ARYSSA JACKMAN RD

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1578154142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZULEMA ARYSSA JACKMAN RD

Provider Business Mailing Address
First Line	:	4539 N 22ND ST STE R
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4639
Country	:	US
Telephone Number	:	602-410-3694
Fax Number	:

Provider Business Practice Location Address
First Line	:	4539 N 22ND ST STE R
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4639
Country	:	US
Telephone Number	:	602-410-3694
Fax Number	:

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

Provider Enumeration Date	:	01/27/2021
Last Update Date	:	12/15/2025

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