Provider Demographics
NPI:1093397721
Name:CURTIS, MARY (HNC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CURTIS
Suffix:
Gender:F
Credentials:HNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 PASEO DEL OCASO STE D
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-3115
Mailing Address - Country:US
Mailing Address - Phone:602-882-7788
Mailing Address - Fax:
Practice Address - Street 1:148 N COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5443
Practice Address - Country:US
Practice Address - Phone:602-882-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10649133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist