Provider Demographics
NPI:1013334986
Name:LYNN TUMPA, RD MPBG
Entity Type:Organization
Organization Name:LYNN TUMPA, RD MPBG
Other - Org Name:LYNN TUMPA, RD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:TUMPA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:310-437-3496
Mailing Address - Street 1:5737 KANAN RD
Mailing Address - Street 2:SUITE 227
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1601
Mailing Address - Country:US
Mailing Address - Phone:310-457-9111
Mailing Address - Fax:
Practice Address - Street 1:5737 KANAN RD
Practice Address - Street 2:SUITE 227
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-1601
Practice Address - Country:US
Practice Address - Phone:310-457-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMHBS130186323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility