Provider Demographics
NPI:1881045375
Name:BOGLE, TRISTINE (RD)
Entity Type:Individual
Prefix:
First Name:TRISTINE
Middle Name:
Last Name:BOGLE
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 1:3564 E MESQUITE ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1830
Mailing Address - Country:US
Mailing Address - Phone:602-622-0142
Mailing Address - Fax:833-561-1964
Practice Address - Street 1:4838 E BASELINE RD STE 122
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4675
Practice Address - Country:US
Practice Address - Phone:602-694-4011
Practice Address - Fax:833-561-1964
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-26
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ913659OtherCOMMISSION ON DIETETIC REGISTRATION