Active NPI
Tami Broderick, R.D.
- Registered Dietitian
- Corona del Mar, CA
National Provider Identifier
1083915714
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 954681
- Practice address
- 436 Heliotrope Ave
Suite 2B
Corona del Mar, CA 92625-2911 - Phone
- (949) 723-9533
- Fax
- (714) 602-1636
- NPI assigned
- Nov 11, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 954681 | CA | Primary |
Addresses
Primary practice location
436 Heliotrope Ave
Suite 2B
Corona del Mar, CA 92625-2911
Mailing address
5181 Argosy Ave
Huntington Beach, CA 92649-1058
Phone (714) 624-7700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 954681 | CA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marjorie Nolan Cohn LLC | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1289433600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1289433600000",
"number": "1083915714",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5181 ARGOSY AVE",
"city": "HUNTINGTON BEACH",
"state": "CA",
"postal_code": "926491058",
"telephone_number": "714-624-7700",
"fax_number": "714-602-1636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "436 HELIOTROPE AVE",
"address_2": "SUITE 2B",
"city": "CORONA DEL MAR",
"state": "CA",
"postal_code": "926252911",
"telephone_number": "949-723-9533",
"fax_number": "714-602-1636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODERICK",
"first_name": "TAMI",
"credential": "R.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-11-11",
"last_updated": "2010-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "954681",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona del Mar, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.