Provider Demographics
NPI:1285026856
Name:CHATHAM, TAHARA (RD)
Entity Type:Individual
Prefix:MRS
First Name:TAHARA
Middle Name:
Last Name:CHATHAM
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 1:700 E NAPLES CT
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6821
Mailing Address - Country:US
Mailing Address - Phone:619-205-1101
Mailing Address - Fax:619-205-1902
Practice Address - Street 1:700 E NAPLES CT
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6821
Practice Address - Country:US
Practice Address - Phone:619-205-1101
Practice Address - Fax:619-205-1902
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930902133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered