Provider Demographics
NPI:1790746212
Name:SWATEK, LILLIAN L (RD)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:L
Last Name:SWATEK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:L
Other - Last Name:LATKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1441 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2837
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4707
Practice Address - Country:US
Practice Address - Phone:480-835-3000
Practice Address - Fax:480-835-8711
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ706857133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ848880Medicaid
78609Medicare ID - Type Unspecified
AZ848880Medicaid