Provider Demographics
NPI:1235618901
Name:LE, TAMMY (RDN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 WICKSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-3448
Mailing Address - Country:US
Mailing Address - Phone:323-629-9637
Mailing Address - Fax:
Practice Address - Street 1:9080 COLIMA RD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-1600
Practice Address - Country:US
Practice Address - Phone:562-907-1762
Practice Address - Fax:562-907-7362
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86031511133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered