Provider Demographics
NPI:1598221053
Name:RED MOUNTAIN DIETITIAN SERVICES LLC
Entity Type:Organization
Organization Name:RED MOUNTAIN DIETITIAN SERVICES LLC
Other - Org Name:RED MOUNTAIN NUTRITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, CDE
Authorized Official - Phone:480-353-8816
Mailing Address - Street 1:2929 N POWER RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1745
Mailing Address - Country:US
Mailing Address - Phone:480-353-8816
Mailing Address - Fax:480-355-5292
Practice Address - Street 1:2929 N POWER RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-1745
Practice Address - Country:US
Practice Address - Phone:480-353-8816
Practice Address - Fax:480-355-5292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty