Provider Demographics
NPI:1538841853
Name:COOPER, TIFFANY JOYCE (MS, RD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JOYCE
Last Name:COOPER
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3957 30TH ST UNIT 408
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3080
Mailing Address - Country:US
Mailing Address - Phone:858-442-3747
Mailing Address - Fax:
Practice Address - Street 1:3957 30TH ST UNIT 408
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-3080
Practice Address - Country:US
Practice Address - Phone:858-442-3747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered