Basic Information
| Provider Information | |||||||||
| NPI: | 1962607556 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMPSON | ||||||||
| FirstName: | ALYSSA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RD, CDE, CLT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 349 E CORONADO RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850041525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024229800 | ||||||||
| FaxNumber: | 6022649101 | ||||||||
| Practice Location | |||||||||
| Address1: | 349 E CORONADO RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850041525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024229800 | ||||||||
| FaxNumber: | 6022649101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2007 | ||||||||
| LastUpdateDate: | 10/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 930584 | AZ | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.