Provider Demographics
NPI:1801467402
Name:ILES, ADENA R (RDN)
Entity type:Individual
Prefix:
First Name:ADENA
Middle Name:R
Last Name:ILES
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5207 W BOBWHITE WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-9483
Mailing Address - Country:US
Mailing Address - Phone:520-628-0609
Mailing Address - Fax:
Practice Address - Street 1:5207 W BOBWHITE WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742-9483
Practice Address - Country:US
Practice Address - Phone:520-628-0609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered