Provider Demographics
NPI:1356831036
Name:CHAPMAN, CECILIA R
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:R
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 E SCORPIO PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-3691
Mailing Address - Country:US
Mailing Address - Phone:480-213-2774
Mailing Address - Fax:480-699-2069
Practice Address - Street 1:1410 W GUADALUPE RD STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3039
Practice Address - Country:US
Practice Address - Phone:480-497-5933
Practice Address - Fax:480-497-5934
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ800312133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered