Provider Demographics
NPI:1992533715
Name:GUADAN FOGALL, TINA (MS, RDN)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:GUADAN FOGALL
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 BEACH DR SW APT 303
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3055
Mailing Address - Country:US
Mailing Address - Phone:206-650-6305
Mailing Address - Fax:
Practice Address - Street 1:3717 BEACH DR SW APT 303
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3055
Practice Address - Country:US
Practice Address - Phone:206-650-6305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered