Provider Demographics
NPI:1780478503
Name:BARTOLOME, TISHA R (RD, RDN)
Entity type:Individual
Prefix:
First Name:TISHA
Middle Name:R
Last Name:BARTOLOME
Suffix:
Gender:
Credentials:RD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 3RD ST APT 221
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4379
Mailing Address - Country:US
Mailing Address - Phone:510-921-8027
Mailing Address - Fax:
Practice Address - Street 1:240 3RD ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4376
Practice Address - Country:US
Practice Address - Phone:510-921-8027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86108653133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered