Provider Demographics
NPI:1790934818
Name:TOM, VALORA JEAN (RD, LD, CDE)
Entity Type:Individual
Prefix:MS
First Name:VALORA
Middle Name:JEAN
Last Name:TOM
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-0589
Mailing Address - Country:US
Mailing Address - Phone:928-729-8828
Mailing Address - Fax:928-729-8045
Practice Address - Street 1:CORNER OF RT N12 & N7
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-8828
Practice Address - Fax:928-729-8045
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL978588133V00000X
NM0816133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered