Organization Active NPI

Defy Diabetes, LLC

  • Registered Dietitian
  • Glendale, AZ
National Provider Identifier
1053818963
Registry record updated Apr 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
926214 Issued in AZ
Legal business name
DEFY DIABETES, LLC
Practice address
18301 N 79TH Ave Ste C136
Glendale, AZ 85308-8471
Phone
(623) 500-6207
NPI assigned
Apr 7, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jaime Lehman, RD, CDE
Title
Owner
Phone
(623) 500-6207

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X 926214 AZ Primary

Addresses

Primary practice location

18301 N 79TH Ave Ste C136
Glendale, AZ 85308-8471

Mailing address

18301 N 79TH Ave Ste C136
Glendale, AZ 85308-8471
Phone (623) 500-6207

Other identifiers 1

IdentifierTypeStateIssuer
1609845916MedicaidAZ

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523059200000",
    "number": "1053818963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18301 N 79TH AVE STE C136",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853088471",
            "telephone_number": "623-500-6207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18301 N 79TH AVE STE C136",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853088471",
            "telephone_number": "623-500-6207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEFY DIABETES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-07",
        "last_updated": "2018-04-07",
        "status": "A",
        "authorized_official_last_name": "LEHMAN",
        "authorized_official_first_name": "JAIME",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-500-6207",
        "authorized_official_credential": "RD, CDE"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "AZ",
            "license": "926214",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609845916",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.