Provider Demographics
NPI:1942835103
Name:NUTRICOACHAZ LLC
Entity Type:Organization
Organization Name:NUTRICOACHAZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROEHR
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN
Authorized Official - Phone:623-258-2608
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-0030
Mailing Address - Country:US
Mailing Address - Phone:623-258-2608
Mailing Address - Fax:
Practice Address - Street 1:9075 S PARKSIDE LN E
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-2448
Practice Address - Country:US
Practice Address - Phone:623-258-2608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1336797471OtherNPPES