Provider Demographics
NPI:1558578989
Name:BALES, EILEEN (RD, CDE)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:BALES
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 W STATE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-8262
Mailing Address - Country:US
Mailing Address - Phone:480-989-4914
Mailing Address - Fax:480-323-4929
Practice Address - Street 1:9700 N 91ST ST
Practice Address - Street 2:SUITE B220
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5054
Practice Address - Country:US
Practice Address - Phone:480-323-4914
Practice Address - Fax:480-323-4929
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZADA REG # 513947133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered