Provider Demographics
NPI:1427675750
Name:OBILA, GIDETTE MICHELENE (RDN)
Entity type:Individual
Prefix:MRS
First Name:GIDETTE
Middle Name:MICHELENE
Last Name:OBILA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MRS
Other - First Name:MICH
Other - Middle Name:
Other - Last Name:ZWINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:1449 W SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-4446
Mailing Address - Country:US
Mailing Address - Phone:480-967-6360
Mailing Address - Fax:480-967-6184
Practice Address - Street 1:1449 W SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-4446
Practice Address - Country:US
Practice Address - Phone:480-967-6360
Practice Address - Fax:480-967-6184
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
AZ86167580133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education