Provider Demographics
NPI:1508010752
Name:TUMPA, LYNN M (RD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:TUMPA
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 1:2614 EUCLID ST APT B
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-4734
Mailing Address - Country:US
Mailing Address - Phone:310-437-3496
Mailing Address - Fax:
Practice Address - Street 1:425 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1102
Practice Address - Country:US
Practice Address - Phone:213-213-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
MD800039133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No172V00000XOther Service ProvidersCommunity Health Worker