Provider Demographics
NPI:1376660357
Name:SOBOL, HANNAH R (RD)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:R
Last Name:SOBOL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:R
Other - Last Name:NORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2149 E WARNER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3494
Mailing Address - Country:US
Mailing Address - Phone:602-610-6100
Mailing Address - Fax:602-610-6195
Practice Address - Street 1:337 E CORONADO RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1583
Practice Address - Country:US
Practice Address - Phone:602-252-8081
Practice Address - Fax:602-252-1520
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ952063133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ198888Medicaid
AZ198888Medicaid