MEDICARE: MRS. ANGELA MARIA SZCZERBIAK 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	133VN1005X	Renal Nutrition Registered Dietitian	164.007817	IL

General Provider Information

NPI Number	:	1578349056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA MARIA SZCZERBIAK RD

Provider Business Mailing Address
First Line	:	5546 W ROOSEVELT ST STE 1
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-2608
Country	:	US
Telephone Number	:	602-352-0724
Fax Number	:

Provider Business Practice Location Address
First Line	:	5546 W ROOSEVELT ST STE 1
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-2608
Country	:	US
Telephone Number	:	602-352-0724
Fax Number	:

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

Provider Enumeration Date	:	08/31/2023
Last Update Date	:	08/31/2023

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