Provider Demographics
NPI:1770115222
Name:TANIESA STANTON
Entity type:Organization
Organization Name:TANIESA STANTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANIESA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANTON
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:818-445-9004
Mailing Address - Street 1:20421 GASPHER CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-8511
Mailing Address - Country:US
Mailing Address - Phone:818-445-9004
Mailing Address - Fax:971-591-8088
Practice Address - Street 1:347 5TH AVE RM 1402
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5034
Practice Address - Country:US
Practice Address - Phone:818-445-9004
Practice Address - Fax:971-591-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty