OrganizationActive
Banner Physician Super Specialists Arizona LLC
NPI 1790337665 · Nutrition Education Nutritionist · Mesa, AZ
Provider details
- NPI number
- 1790337665
- Entity type
- Organization
- Primary specialty
- Nutrition Education NutritionistDietary & Nutritional Service Providers
- Parent organization
- Banner Health
- Authorized official
- Dennis Laraway, Cfo
Mailing address
2901 N Central Ave Ste 160
Phoenix, AZ 85012-2702
Registry dates
- Enumerated
- 2019-07-11
- Last updated
- 2021-12-28
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.