Provider Demographics
NPI:1144644733
Name:AGUIRRE, SMITA NICOLE (RD)
Entity type:Individual
Prefix:
First Name:SMITA
Middle Name:NICOLE
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SMITA
Other - Middle Name:NICOLE
Other - Last Name:MULIYIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2108 E THOMAS RD STE 130
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-0008
Mailing Address - Country:US
Mailing Address - Phone:602-933-3124
Mailing Address - Fax:
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-933-0970
Practice Address - Fax:602-933-4253
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
992715133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric