Provider Demographics
NPI:1457735821
Name:HOLZ, TINA (RD)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:HOLZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 E JOAN D ARC AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4705
Mailing Address - Country:US
Mailing Address - Phone:602-535-4864
Mailing Address - Fax:
Practice Address - Street 1:122 E JOAN D ARC AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4705
Practice Address - Country:US
Practice Address - Phone:602-535-4864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ961113133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered