Provider Demographics
NPI:1083040448
Name:CAPOBIANCO, TIFFANY B (NUTRITION CONSULTANT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:B
Last Name:CAPOBIANCO
Suffix:
Gender:F
Credentials:NUTRITION CONSULTANT
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:B
Other - Last Name:DALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41990 COOK ST STE 2006
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6105
Mailing Address - Country:US
Mailing Address - Phone:760-285-1221
Mailing Address - Fax:
Practice Address - Street 1:41990 COOK ST STE 2006
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6105
Practice Address - Country:US
Practice Address - Phone:760-285-1221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education