Provider Demographics
NPI:1760535033
Name:TIA, NATALIE P (RD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:P
Last Name:TIA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:A
Other - Last Name:PETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:864 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-7006
Mailing Address - Country:US
Mailing Address - Phone:714-602-7117
Mailing Address - Fax:
Practice Address - Street 1:864 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-7006
Practice Address - Country:US
Practice Address - Phone:714-602-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2025-08-01
Deactivation Date:2018-11-08
Deactivation Code:
Reactivation Date:2025-08-01
Provider Licenses
StateLicense IDTaxonomies
HI837195133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI54677Medicare UPIN