Provider Demographics
NPI:1952062275
Name:SOUTHWEST DIETITIAN GROUP LLC
Entity type:Organization
Organization Name:SOUTHWEST DIETITIAN GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:NAHRA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:216-533-4023
Mailing Address - Street 1:70 S VAL VISTA DR STE A3-527
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-0944
Mailing Address - Country:US
Mailing Address - Phone:602-218-5278
Mailing Address - Fax:844-218-4691
Practice Address - Street 1:428 S GILBERT RD STE 106-2
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-2263
Practice Address - Country:US
Practice Address - Phone:602-218-5278
Practice Address - Fax:844-218-4691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-08
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty