Provider Demographics
NPI:1811550833
Name:ANDREWS, LUPE LETICIA (RD, CHWC)
Entity Type:Individual
Prefix:
First Name:LUPE
Middle Name:LETICIA
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:RD, CHWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12430 N 79TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-4821
Mailing Address - Country:US
Mailing Address - Phone:623-217-9191
Mailing Address - Fax:
Practice Address - Street 1:12430 N 79TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-4821
Practice Address - Country:US
Practice Address - Phone:623-217-9191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ655909133V00000X
CA655909133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered