Provider Demographics
NPI:1164970901
Name:BERBEROVICH, TINA MICHELLE (RD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MICHELLE
Last Name:BERBEROVICH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3848 VETERANS MEMORIAL BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002
Mailing Address - Country:US
Mailing Address - Phone:504-885-2505
Mailing Address - Fax:504-885-2510
Practice Address - Street 1:3848 VETERANS MEMORIAL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002
Practice Address - Country:US
Practice Address - Phone:504-885-2505
Practice Address - Fax:504-885-2510
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2670133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered