Provider Demographics
NPI:1508966284
Name:TAYLOR, TRACY L (RD CDE)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 MARIN RD
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-1321
Mailing Address - Country:US
Mailing Address - Phone:510-334-5097
Mailing Address - Fax:
Practice Address - Street 1:2433 CENTRAL AVE
Practice Address - Street 2:STE A
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4564
Practice Address - Country:US
Practice Address - Phone:510-521-2300
Practice Address - Fax:510-974-8322
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered