Provider Demographics
NPI:1477746550
Name:TRIBOLE, EVELYN (MS, RD)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:TRIBOLE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 QUAIL ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2701
Mailing Address - Country:US
Mailing Address - Phone:949-654-9904
Mailing Address - Fax:
Practice Address - Street 1:1100 QUAIL ST
Practice Address - Street 2:SUITE 111
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2701
Practice Address - Country:US
Practice Address - Phone:949-654-9904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA681168OtherREGISTERED DIETITIAN - AM DIETETIC ASSOC