Provider Demographics
NPI:1033917026
Name:TARTIBI, KOOROSH
Entity type:Individual
Prefix:
First Name:KOOROSH
Middle Name:
Last Name:TARTIBI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8374 ROTHMAN ALY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7780
Mailing Address - Country:US
Mailing Address - Phone:407-353-0408
Mailing Address - Fax:
Practice Address - Street 1:8374 ROTHMAN ALY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7780
Practice Address - Country:US
Practice Address - Phone:407-353-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86212038133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered