MEDICARE: DIANA JEAN COX R.D.

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	:	1639312564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA JEAN COX R.D.

Provider Business Mailing Address
First Line	:	302 W CALLE MONTERO
Second Line	:
City	:	SAHUARITA
State	:	AZ
Zip	:	85629-8545
Country	:	US
Telephone Number	:	520-289-5093
Fax Number	:

Provider Business Practice Location Address
First Line	:	2022 E PRINCE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-2005
Country	:	US
Telephone Number	:	520-625-0103
Fax Number	:	520-625-0107

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

Provider Enumeration Date	:	04/07/2009
Last Update Date	:	04/07/2009

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