| Southern Az Nutrition Consultants, Llc | |
|
1100 E Ajo Way Ste 212 Tucson AZ 85713-5055 | |
| (520) 904-0889 | |
| Not Available |
| Full Name | Southern Az Nutrition Consultants, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1100 E Ajo Way Ste 212, Tucson, Arizona |
| Authorized Official Name and Position | Javier Gomez (OWNER, OPERATOR) |
| Authorized Official Contact | 5209040889 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Az Nutrition Consultants, Llc 11414 E Squash Blossom Loop Tucson AZ 85747-6219 Ph: (520) 904-0889 | Southern Az Nutrition Consultants, Llc 1100 E Ajo Way Ste 212 Tucson AZ 85713-5055 Ph: (520) 904-0889 |
| NPI Number | 1013472158 |
|---|---|
| Provider Enumeration Date | 02/03/2019 |
| Last Update Date | 07/22/2019 |
| Medicare PECOS PAC ID | 8921333469 |
|---|---|
| Medicare Enrollment ID | O20190812001327 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013472158 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Javier Gomez |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1720196801 PECOS PAC ID: 7012242555 Enrollment ID: I20190705000581 |
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