Basic Information
| Provider Information | |||||||||
| NPI: | 1174677355 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLASS | ||||||||
| FirstName: | AKEMI | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | R.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SATO | ||||||||
| OtherFirstName: | AKEMI | ||||||||
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| OtherCredential: | R.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1010 N COUNTRY CLUB DR | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852013309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804612409 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2000 CAMPBELL DR | ||||||||
| Address2: | |||||||||
| City: | TORRINGTON | ||||||||
| State: | WY | ||||||||
| PostalCode: | 822401528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3075324181 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 841164 | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.