Provider Demographics
NPI:1346908118
Name:ATTOBRA, TATIANA MARIA
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:MARIA
Last Name:ATTOBRA
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 1:29352 FLAME TREE
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4779
Mailing Address - Country:US
Mailing Address - Phone:805-276-2717
Mailing Address - Fax:
Practice Address - Street 1:36320 INLAND VALLEY DR STE 101
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7512
Practice Address - Country:US
Practice Address - Phone:951-698-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86046414133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86046414OtherCOMMISSION ON DIETETIC REGISTRATION