Provider Demographics
NPI:1942698667
Name:TASH, HEIDI KATHLEEN (RD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:KATHLEEN
Last Name:TASH
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 1:2016 24TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-1802
Mailing Address - Country:US
Mailing Address - Phone:916-730-0723
Mailing Address - Fax:
Practice Address - Street 1:2016 24TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-1802
Practice Address - Country:US
Practice Address - Phone:916-730-0723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1021099133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered