NPI 1578125738

Banner Physician Super Specialists Arizona LLC

Organisation Nutrition Education Nutritionist Glendale, AZ

Practice location

Address: 5310 W Thunderbird Rd STE 214, Glendale, AZ 85306-4722
Phone: (602) 865-4480
Mailing address: 2901 N Central Ave STE 160, Phoenix, AZ 85012-2702

Authorised official

Name: Dennis Laraway
Title: Cfo
Phone: (602) 747-4000

Registered specialties (2)

Nutrition Education Nutritionist Primary

Dietary & Nutritional Service Providers Taxonomy 133NN1002X

Other Nutritionist providers in Arizona →

Multi-Specialty Clinic/Center

Ambulatory Health Care Facilities Taxonomy 261QM1300X

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Registry record

NPI: 1578125738
Entity type: Organization
NPI issued: 8 Jul 2019
Record last updated: 28 Dec 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.