Provider Demographics
NPI:1518999077
Name:YALEN, ILENE BETH (MSRD)
Entity Type:Individual
Prefix:MRS
First Name:ILENE
Middle Name:BETH
Last Name:YALEN
Suffix:
Gender:F
Credentials:MSRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8615 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-7205
Mailing Address - Country:US
Mailing Address - Phone:520-792-1450
Mailing Address - Fax:520-629-4721
Practice Address - Street 1:7301 E 22ND ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6426
Practice Address - Country:US
Practice Address - Phone:520-909-6866
Practice Address - Fax:520-305-4304
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ872983133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered