MEDICARE: TIFFANY B CAPOBIANCO NUTRITION CONSULTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	133N00000X	Nutritionist
2	390200000X	Student in an Organized Health Care Education/Training Program	CA
3	133NN1002X	Nutrition Education Nutritionist

General Provider Information

NPI Number	:	1083040448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY B CAPOBIANCO NUTRITION CONSULTANT

Provider Business Mailing Address
First Line	:	41990 COOK ST STE 2006
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-6105
Country	:	US
Telephone Number	:	760-285-1221
Fax Number	:

Provider Business Practice Location Address
First Line	:	41990 COOK ST STE 2006
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-6105
Country	:	US
Telephone Number	:	760-285-1221
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2013
Last Update Date	:	02/10/2026

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Directions to “ TIFFANY B CAPOBIANCO NUTRITION CONSULTANT” Practice Location

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