Healthcare Provider Details

I. General information

NPI: 1033042387
Provider Name (Legal Business Name): NORTHBAY HEALTH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 B GALE WILSON BLVD
FAIRFIELD CA
94533-3587
US

IV. Provider business mailing address

1200 B GALE WILSON BLVD
FAIRFIELD CA
94533-3587
US

V. Phone/Fax

Practice location:
  • Phone: 707-646-5000
  • Fax:
Mailing address:
  • Phone: 707-646-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: TASHIRA ALEXANDER
Title or Position: CLINICAL DIETITIAN
Credential: RDN
Phone: 661-742-8072