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General NPI Number Information
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NPI Number | 1326762659
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Entity Type | Individual
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Provider Name | DEBORA W TINGLEY PHD, MS
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Gender | Female
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Dates
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Enumeration Date | 09/29/2022
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 909 ALVARADO RD
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City | BERKELEY
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State | CA
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Zip | 94705-1551
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Country | US
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Telephone | 415-409-8996
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Fax |
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Provider Business Mailing Address
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Address Line | 2512 TELEGRAPH AVE # 140
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City | BERKELEY
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State | CA
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Zip | 94704-2918
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Country | US
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Telephone | 415-409-8996
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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