Provider Demographics
NPI:1619595170
Name:HOBBS, LANDON (RD)
Entity Type:Individual
Prefix:
First Name:LANDON
Middle Name:
Last Name:HOBBS
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4847 E HARMONY AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3406
Mailing Address - Country:US
Mailing Address - Phone:601-580-4699
Mailing Address - Fax:
Practice Address - Street 1:4847 E HARMONY AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3406
Practice Address - Country:US
Practice Address - Phone:601-580-4699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86073432133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered