Provider Demographics
NPI:1134280472
Name:SHEARER, LUZ-ELENA (RD)
Entity Type:Individual
Prefix:
First Name:LUZ-ELENA
Middle Name:
Last Name:SHEARER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMG CREDENTIALING
Mailing Address - Street 2:2202 N. FORBES BLVD.
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745
Mailing Address - Country:US
Mailing Address - Phone:520-872-7265
Mailing Address - Fax:520-872-7963
Practice Address - Street 1:CARONDELET MEDICAL GROUP
Practice Address - Street 2:3939 S. PARK, #150
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714
Practice Address - Country:US
Practice Address - Phone:520-746-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL713260133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ963779Medicaid
AZ963779Medicaid