Provider Demographics
NPI:1073913737
Name:PERRINO, CARIE (NMD, RDN)
Entity Type:Individual
Prefix:
First Name:CARIE
Middle Name:
Last Name:PERRINO
Suffix:
Gender:F
Credentials:NMD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 E BASELINE RD STE D208
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1298
Mailing Address - Country:US
Mailing Address - Phone:480-914-0521
Mailing Address - Fax:480-914-0522
Practice Address - Street 1:123 E BASELINE RD STE D208
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1298
Practice Address - Country:US
Practice Address - Phone:480-914-0521
Practice Address - Fax:480-914-0522
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-01
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22-1748175F00000X
IL164006255133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered