Healthcare Provider Details

I. General information

NPI: 1679943278
Provider Name (Legal Business Name): TAMAR LEAH JEHAN SAMUELS RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 ADDISON ST STE A
BERKELEY CA
94704-1354
US

IV. Provider business mailing address

1935 ADDISON ST STE A
BERKELEY CA
94704-1354
US

V. Phone/Fax

Practice location:
  • Phone: 707-646-9359
  • Fax: 341-250-3106
Mailing address:
  • Phone: 707-646-9359
  • Fax: 341-250-3106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number008273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: