Provider Demographics
NPI:1033694096
Name:FRIESON, TIFFANY CLARICE (MS, RDN)
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:CLARICE
Last Name:FRIESON
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1628
Mailing Address - Street 2:
Mailing Address - City:LAKE ISABELLA
Mailing Address - State:CA
Mailing Address - Zip Code:93240-1628
Mailing Address - Country:US
Mailing Address - Phone:760-379-2681
Mailing Address - Fax:760-379-2321
Practice Address - Street 1:6412 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:LAKE ISABELLA
Practice Address - State:CA
Practice Address - Zip Code:93240-9529
Practice Address - Country:US
Practice Address - Phone:760-379-2681
Practice Address - Fax:760-379-4795
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86065532133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered