MEDICARE: TARA MORAN RDN LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1558140590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARA MORAN RDN LLC

Provider Business Mailing Address
First Line	:	16835 ALGONQUIN ST # 238
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-3810
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5904 WARNER AVE UNIT 409
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-4670
Country	:	US
Telephone Number	:	562-476-9017
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED DIETITIAN-NUTRITIONIST
Name	:	TARA DURDEN
Credential	:	RDN
Telephone Number	:	562-476-9017

Provider Enumeration Date	:	09/28/2023
Last Update Date	:	06/17/2024

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