Active NPI
Alexa Marie Diaz, RD
- Registered Dietitian
- Phoenix, AZ
National Provider Identifier
1922376193
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86002413
- Practice address
- 635 East Baseline Road
Phoenix, AZ 85042-6551 - Phone
- (602) 243-7277
- Fax
- (602) 243-1235
- NPI assigned
- Dec 2, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | |||
| Registered Dietitian | 133V00000X | 86002413 | AZ | Primary |
Addresses
Primary practice location
635 East Baseline Road
Phoenix, AZ 85042-6551
Mailing address
2702 North 3Rd Street
4020
Phoenix, AZ 85004-4608
Phone (602) 323-3407
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 701269 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86002413 | AZ | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mountain Park Health Center | Past | Accepting new patients | |
| Mountain Park Health Center - Dental | Past | Accepting new patients | |
| Mountain Park Health Center | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Phoenix, AZ
- NPI 1386741668
-
- Federally Qualified Health Center (FQHC)
- Phoenix, AZ
- NPI 1669878567
-
- Federally Qualified Health Center (FQHC)
- Phoenix, AZ
- NPI 1710146188
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350000000000",
"number": "1922376193",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2702 NORTH 3RD STREET",
"address_2": "4020",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850044608",
"telephone_number": "602-323-3407",
"fax_number": "602-323-3496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "635 EAST BASELINE ROAD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850426551",
"telephone_number": "602-243-7277",
"fax_number": "602-243-1235"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAZ",
"first_name": "ALEXA",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-12-02",
"last_updated": "2012-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": null,
"license": null,
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "AZ",
"license": "86002413",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "701269",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.