Healthcare Provider Details

I. General information

NPI: 1548345564
Provider Name (Legal Business Name): FLORENCE ANN TISCARENO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR 60TH MDG/60MDTS/SGQD DAVID GRANT MEDICAL CENTER
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

2220 OAK HILLS CIR APT 38
PITTSBURG CA
94565-4223
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-3668
  • Fax: 707-423-3627
Mailing address:
  • Phone: 925-261-1824
  • 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:
Title or Position:
Credential:
Phone: