Provider Demographics
NPI:1326762659
Name:TINGLEY, DEBORA W (PHD, MS)
Entity Type:Individual
Prefix:DR
First Name:DEBORA
Middle Name:W
Last Name:TINGLEY
Suffix:
Gender:F
Credentials:PHD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 TELEGRAPH AVE # 140
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2918
Mailing Address - Country:US
Mailing Address - Phone:415-409-8996
Mailing Address - Fax:
Practice Address - Street 1:909 ALVARADO RD
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1551
Practice Address - Country:US
Practice Address - Phone:415-409-8996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist