Provider Demographics
NPI:1790584241
Name:TULLGREN, REBECCA (RDN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:TULLGREN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 N LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-1834
Mailing Address - Country:US
Mailing Address - Phone:714-612-3011
Mailing Address - Fax:
Practice Address - Street 1:18182 PEPPERGROVE ST
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-5240
Practice Address - Country:US
Practice Address - Phone:714-612-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI375133V00000X
FL10338133V00000X
CA805593133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered