Provider Demographics
NPI:1639763337
Name:SIRMONS, MICHELLE (RD, CSSD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SIRMONS
Suffix:
Gender:F
Credentials:RD, CSSD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CSSD
Mailing Address - Street 1:871 W ORIOLE WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-4472
Mailing Address - Country:US
Mailing Address - Phone:951-733-9555
Mailing Address - Fax:
Practice Address - Street 1:871 W ORIOLE WAY
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-4472
Practice Address - Country:US
Practice Address - Phone:951-733-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1053921133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics