Provider Demographics
NPI:1851644918
Name:NUTRITIONAL SERVICES OF SOUTHERN ARIZONA, INC.
Entity Type:Organization
Organization Name:NUTRITIONAL SERVICES OF SOUTHERN ARIZONA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PICCHIONI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-954-2551
Mailing Address - Street 1:850 N KOLB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1333
Mailing Address - Country:US
Mailing Address - Phone:520-954-2551
Mailing Address - Fax:520-393-3326
Practice Address - Street 1:850 N KOLB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1333
Practice Address - Country:US
Practice Address - Phone:520-954-2551
Practice Address - Fax:520-393-3326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty