Provider Demographics
NPI:1154128221
Name:FIM HEALTH
Entity type:Organization
Organization Name:FIM HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUANLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:480-639-9327
Mailing Address - Street 1:112 N CENTRAL AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2309
Mailing Address - Country:US
Mailing Address - Phone:480-382-2139
Mailing Address - Fax:
Practice Address - Street 1:112 N CENTRAL AVE FL 1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2309
Practice Address - Country:US
Practice Address - Phone:480-382-2139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty