Provider Demographics
NPI:1568701514
Name:MY DIETITIAN LLC
Entity Type:Organization
Organization Name:MY DIETITIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TINGEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1866-456-6226
Mailing Address - Street 1:7702 E DOUBLETREE RANCH RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-2132
Mailing Address - Country:US
Mailing Address - Phone:186-645-6622
Mailing Address - Fax:480-718-7422
Practice Address - Street 1:7702 E DOUBLETREE RANCH RD STE 300
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-2132
Practice Address - Country:US
Practice Address - Phone:186-645-6622
Practice Address - Fax:480-718-7422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty