Provider Demographics
NPI:1306387451
Name:TOROK, TIFFANY (RD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:TOROK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:EPPERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:1640 NORTHSTAR DR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-6622
Mailing Address - Country:US
Mailing Address - Phone:415-845-8654
Mailing Address - Fax:
Practice Address - Street 1:1640 NORTHSTAR DR
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-6622
Practice Address - Country:US
Practice Address - Phone:415-845-8654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86021914133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered