Provider Demographics
NPI:1528672706
Name:KEAY, TATIANA (RD)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:KEAY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 PASEO MARGUERITA
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-2560
Mailing Address - Country:US
Mailing Address - Phone:909-362-1748
Mailing Address - Fax:
Practice Address - Street 1:327 PASEO MARGUERITA
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-2560
Practice Address - Country:US
Practice Address - Phone:909-362-1748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86091256133V00000X, 133VN1201X
86091256133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA86091256OtherREGISTERED DIETITIAN