Provider Demographics
NPI:1942649736
Name:TIBBITTS, CHERYL ELAINE (RD)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ELAINE
Last Name:TIBBITTS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:ELAINE
Other - Last Name:OHRMUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:MAIL DROP 4S-205
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:858-927-5755
Mailing Address - Fax:
Practice Address - Street 1:10140 CAMPUS POINT DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1520
Practice Address - Country:US
Practice Address - Phone:858-678-7050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT84520634901133V00000X
CA1095153133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered