Provider Demographics
NPI:1508334913
Name:ISHIZU, MAKI (RD)
Entity Type:Individual
Prefix:
First Name:MAKI
Middle Name:
Last Name:ISHIZU
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 1:8950 E LOWRY BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7030
Mailing Address - Country:US
Mailing Address - Phone:303-912-7193
Mailing Address - Fax:
Practice Address - Street 1:8405 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2908
Practice Address - Country:US
Practice Address - Phone:720-974-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered