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NPI Code Detail

MEDICARE: TAMI JO LYON RD

MEDICARE: TAMI JO LYON RD
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
1133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1568703502
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMI JO LYON RD
Provider Business Mailing Address
First Line : 3608 SACRAMENTO ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94118-1736
Country : US
Telephone Number : 415-345-1354
Fax Number : 888-945-6887
Provider Business Practice Location Address
First Line : 3608 SACRAMENTO ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94118-1736
Country : US
Telephone Number : 415-345-1354
Fax Number : 888-945-6887
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2013
Last Update Date : 03/14/2013

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