Provider Demographics
NPI:1245748680
Name:VAN TASSEL, CHRISTINE ANN
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN
Last Name:VAN TASSEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12245 CARMEL VISTA RD UNIT 290
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2532
Mailing Address - Country:US
Mailing Address - Phone:619-549-5522
Mailing Address - Fax:
Practice Address - Street 1:12245 CARMEL VISTA RD UNIT 290
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2532
Practice Address - Country:US
Practice Address - Phone:619-549-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist