Provider Demographics
NPI:1003210683
Name:VOSS, TAMMIE (MA, RDN)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:
Last Name:VOSS
Suffix:
Gender:F
Credentials:MA, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11501 MARCELLO WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-9204
Mailing Address - Country:US
Mailing Address - Phone:760-252-6202
Mailing Address - Fax:760-252-6333
Practice Address - Street 1:100 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-7003
Practice Address - Country:US
Practice Address - Phone:760-252-6202
Practice Address - Fax:760-252-6333
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA727062133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered