Provider Demographics
NPI:1740282821
Name:ARIZONA DIABETES AND NUTRITION EDUCATION, LLC
Entity type:Organization
Organization Name:ARIZONA DIABETES AND NUTRITION EDUCATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MALAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-217-4861
Mailing Address - Street 1:3707 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2569
Mailing Address - Country:US
Mailing Address - Phone:480-217-4861
Mailing Address - Fax:480-626-1551
Practice Address - Street 1:3707 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2569
Practice Address - Country:US
Practice Address - Phone:480-217-4861
Practice Address - Fax:480-626-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ706851133V00000X
AZRN0518449163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Not Answered163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty