Provider Demographics
NPI:1508095126
Name:KARAM, GUADALUPE (RD)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:KARAM
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:PO BOX 31233
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1233
Mailing Address - Country:US
Mailing Address - Phone:520-241-6264
Mailing Address - Fax:
Practice Address - Street 1:4205 E LA CIENEGA DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1425
Practice Address - Country:US
Practice Address - Phone:520-241-6264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ85002250133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ85002250OtherRD CERTIFICATE