Tammy Petrossian, RD, CSP, CNSD

Primary specialty

Pediatric Nutrition Registered DietitianTaxonomy code 133VN1004X

License

816014 Issued in CA

Practice address

1014 San Juan Ave
Exeter, CA 93221-1312

Phone

(559) 592-7360

Fax

(559) 592-5629

NPI assigned

Mar 9, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268092800000",
    "number": "1811210511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1631 E FOREST OAKS DR",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937304535",
            "telephone_number": "559-434-6332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 SAN JUAN AVE",
            "city": "EXETER",
            "state": "CA",
            "postal_code": "932211312",
            "telephone_number": "559-592-7360",
            "fax_number": "559-592-5629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROSSIAN",
        "first_name": "TAMMY",
        "credential": "RD, CSP, CNSD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-09",
        "last_updated": "2010-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": "816014",
            "primary": false
        },
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "CA",
            "license": "816014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dawn Parsley, NP
• Mandar Harshit Patel, PT
• Michelle Pengilly, ED.D.
• Stefan I Pentschev, M.D.
• Antonio Perez, AS
• Binh Pham, BA
• Andy Phan, MD
• Toni Michelle Pinkerton, LMFT
• Barbara Pitcock
• Purpose Driven Healthcare LLC

• Pediatric Nutrition Registered Dietitian in Exeter, CA
• Providers in Exeter, CA by specialty
• Pediatric Nutrition Registered Dietitian in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 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.

Verify at the official NPI Registry.