Healthcare Provider Details

I. General information

NPI: 1083040448
Provider Name (Legal Business Name): TIFFANY B CAPOBIANCO NUTRITION CONSULTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANY B DALTON

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41990 COOK ST STE 2006
PALM DESERT CA
92211-6105
US

IV. Provider business mailing address

41990 COOK ST STE 2006
PALM DESERT CA
92211-6105
US

V. Phone/Fax

Practice location:
  • Phone: 760-285-1221
  • Fax:
Mailing address:
  • Phone: 760-285-1221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: