Active NPI
Phyllis Tindall
- Nutritionist
- Redondo Beach, CA
National Provider Identifier
1679782288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- 000510
- Practice address
- 1926 S Pacific Coast Hwy Ste 203
Redondo Beach, CA 90277-6145 - Phone
- (310) 210-8233
- NPI assigned
- May 21, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Nutritionist | 133N00000X | 000510 | CA | Primary |
Addresses
Primary practice location
1926 S Pacific Coast Hwy Ste 203
Redondo Beach, CA 90277-6145
Mailing address
3151 S Leland St
San Pedro, CA 90731-6139
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 |
|---|---|---|---|
| 000510 | CA | MD | Genetic Counselor (M.S.) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679782288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3151 S LELAND ST",
"city": "SAN PEDRO",
"state": "CA",
"postal_code": "907316139"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1926 S PACIFIC COAST HWY STE 203",
"city": "REDONDO BEACH",
"state": "CA",
"postal_code": "902776145",
"telephone_number": "310-210-8233"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TINDALL",
"first_name": "PHYLLIS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "CA",
"license": "000510",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redondo Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.