Provider Demographics
NPI:1851412050
Name:JAN TILLEY & ASSOCIATES
Entity Type:Organization
Organization Name:JAN TILLEY & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:TILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DIETITIAN
Authorized Official - Phone:210-545-4422
Mailing Address - Street 1:400 N LOOP 1604 E
Mailing Address - Street 2:SUITE 175
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1258
Mailing Address - Country:US
Mailing Address - Phone:210-545-4422
Mailing Address - Fax:210-545-4495
Practice Address - Street 1:400 N LOOP 1604 E
Practice Address - Street 2:SUITE 175
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1258
Practice Address - Country:US
Practice Address - Phone:210-545-4422
Practice Address - Fax:210-545-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDY04462133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty